,  [SCPBOOKOF 
.IE NURSING  PROCEDURE 

1  HIGH  SCHOOLS 


RT41 
F81t 


A  textbook  of 
simple  nursing" 


Southern  Branch 
of  the 

University  of  California 

Los  Angeles 

Form  L-l 


41 


This  book   is  DUE  on  the   last   date  stamped  below 


AUG  6 

APR     ? 

J»JL  2  5 


'-o    101928 

WAI:  2.9  1937 
AUG  2    1952 


Form  I.  '.>-8m-7,>22 ' 


A  Textbook  of 
Simple  Nursing  Procedure 

For  Use  in  High  Schools 

Together  with  Instructions  for 
First  Aid  in   Emergencies 


By 

Amy  E.  Pope 

Formerly  Instructor  in    the    School   of  Nursing,    Presbyterian 

Hospital,   New  York;    Visiting  Instructor,  San  Francisco 

Author    of   "  A    Medical    Dictionary    for    Nurses," 

"A    Quiz    Book   of  Nursing,"    "  Essentials  of 

Dietetics,"     "  A     Dietary     Computer," 

"  Anatomy  and  Physiology,"  "  Nurs-. 

ib£  FrocttfurV,"  end,   with  Aniin"  .'  '.  \.'  '.'.'.*,    ', 
•  .-  .     »         .Mexwrfl,   of   •^•P  * 

Nursing  " 


Illustrated 


G.  P.  Putnam's  Sons 
New  York   and    London 

Cbc     t^iuchcrbochcr     prc00 

'40155 


Copyright.  1921 

by 
G.  P.  Putnam's  Sons 

Printed  in  the  United  States  of  America 


* 

S/  p     9s   \   t 


PREFACE 

« 

Every  woman  should  have  some  knowledge  of 

^the  methods  used  in  caring  for  the  sick  and  of  the 

O^first-aid  treatment  required  in  common  emergen- 

<jcies  and,  if  these  essentials  are  not  taught  in  the 

-"  schools,  the  great  majority  of  women  will  never 

^know  them. 

Q     Many  people  say,  "I  do  not  believe  in  so  much 

la  talk  about  health,  it  was  not  considered  necessary 

ft  when  I  was  young,"  and  so  forth,  but  it  is  to 

9  be  appreciated  that  one  third  of  the  seemingly 

j  healthy  men  who  applied  for  military  duty  dur- 

5  ing  the  last  war  (who  were  reared  under  the  present 

<G  regime]  were  turned  down  because  of  physical  dis- 

{  ability,  and  a  most  deplorable  condition  among 

school   children   is   indicated   by   the   following 

statistics,  recently  collected  from  official  sources 

and  made  public  by  Dr.  Wood : 

"At  least  i  percent.—  200,000— of  the  20,000,000 
school  children  in  the  United  States,  are  mentally 
defective. 

"Over  I   per  cent. — 250,000  at  least — of  the 
children  are  handicapped  by  organic  heart  disease. 
"At  least  5  per  cent. — 1 ,000,000— have  now  or 
have  had  tuberculosis. 

"  Five  per  ceht.  —  1 ,000,000  —  have  defective 

iii 


iv  Preface 

hearing  which  when  unrecognized,  gives  them  the 
undeserved  reputation  of  being  mentally  defective. 

"Twenty -five  per  cent,  have  defective  eyes. 

"About  25  per  cent. — 5,000,000 — are  suffering 
from  malnutrition. 

"From  15  to  25  per  cent. — 3,000,000  to  5,000,- 
ooo — have  adenoids  or  glandular  defects. 

"From  10  to  20  per  cent,  have  weak  foot  arches, • 
weak  spines,  or  other  joint  defects. 

"From  50  to  75  per  cent,  have  defective 
teeth." 

To   summarize,    75   per   cent. — 15,000,000 — of  » 
the  20,000,000  children  in  the  schools  of  the  United 
States  have  physical  defects  which  are  potentially 
or  actually  detrimental  to  health. 

Undoubtedly,  a  large  number  of  these  defects 
are  the  result  of  lack  of  hygienic  living  and  many 
of  them  could  be  rectified  if  parents  appreciated 
the  seriousness  of  the  conditions  sufficiently  to 
seek  medical  advice  and  knew  enough  about  the 
simpler  treatments  and  nursing  methods  to  enable 
them  to  carry  out  a  physician's  or  nurse's  in- 
structions correctly. 

It  is  chiefly  treatments  and  nursing  care  that 
are  described  in  this  book  and,  in  compiling  it, 
the  author  has  selected  procedures  of  which  knowl- 
edge is  particularly  essential  for  young  girls  who 
may  have  to  help  care  for  their  sick.  With  a  few 
exceptions  the  procedures  can  be  taught  in  the 
classroom  and  only  methods  that  can  be  used  by 
the  inexperienced  are  included.  But,  though  the 


Preface  v 

descriptions  are  arranged  to  facilitate  classroom 
teaching,  details  of  procedures  that  cannot  well  be 
carried  out  in  public  but  are  likely  to  be  necessary 
in  the  care  of  a  sick  person,  are  also  included. 

AMY  ELIZABETH  POPE. 


Suggestions  for  Methods  of  Teaching 

The  teacher  of  nursing  procedures  is  frequently 
confronted  with  two  opposing  pedagogic  require- 
ments, namely:  (i)  To  encourage  the  students' 
ingenuity  and  their  ability  to  follow  written  and 
verbal  instruction;  (2)  Not  to  allow  the  pupils 
to  become  confused  between  right  and  wrong 
methods  by  seeing  procedures  wrongly  performed. 
Probably  this  has  to  be  more  frequently  guarded 
against  in  teaching  nursing  procedures  than  almost 
any  other  variety  of  technical  work  because  errors 
in  technique  may  in  some  instances  be  followed 
by  disastrous  results.  For  this  reason,  and  also  to 
save  time,  it  is  frequently  necessary  for  the  instruc- 
tor to  demonstrate  the  procedures  before  the  pupils 
attempt  to  carry  them  out.  It  is  for  this  reason 
that  the  descriptions  of  methods  have  been  entitled 
demonstrations.  However,  the  descriptions  are 
given  in  such  a  manner  that  the  pupils  should 
be  able  to  cany  out  some  of  the  simpler  pro- 
cedures without  being  shown  how  to  do  so  and 
to  follow  the  directions  when  practicing  in  their 
homes. 

Even  when  the  procedures  are  to  be  demon- 
strated, the  author  would  advise  that  the  pupils 
be  required  to  read  the  description  of  the  demon- 

vii 


viii          Methods  of  Teaching 

stration  and  related  matter  in  preparation  for 
class,  since  they  will  then  be  better  prepared  to 
understand  and  remember  what  they  are  shown. 
Also,  it  is  well  to  allot  a  portion  of  each  class  time 
for  a  quiz. 


CONTENTS 

PACK 

EQUIPMENT  FOR  DEMONSTRATION  ROOM  .         .         i 

CHAPTER   I 

CARE  OF  THE  SICK-ROOM  AND  OF  UTENSILS 
COMMONLY  EMPLOYED  IN  THE  TREAT- 
MENT OF  THE  SICK  ....  6 

Ideal  location  and  characteristics  of  a  sick-room. 
Suitable  furnishings  for  a  sick-room.  The  natural 
phenomena  upon  which  ventilation  and  the  puri- 
fication of  the  air  depend.  The  reasons  for  the 
unpleasant  effects  experienced  when  in  a  poorly  venti- 
lated room.  Some  methods  of  ventilation.  Why 
cleanliness  is  necessary  to  prevent  the  transmission 
of  disease  and  the  ways  in  which  some  of  the  more 
common  communicable  diseases  are  transmitted. 
Important  rules  to  observe  when  sweeping  and  dust- 
ing. Methods  of  cleaning  and  disinfecting  utensils 
commonly  used  in  the  care  of  the  sick.  Demon- 
stration i :  Methods  of  ventilating  and  cleaning  a 
sick-room.  Care  of  utensils  used  for  the  sick. 

CHAPTER   II 

METHODS  OF  MOVING,  LIFTING,  AND  CARRY- 
ING PATIENTS  ...  -37 

Important  points  to  remember  when  moving,  lift- 
ing, and  carrying  people.  Demonstration  2:  How  to: 
Raise  a  patient's  head;  turn  a  patient  on  her  side; 
draw  her  to  the  side  of  the  bed;  move  her  up  in  bed; 
raise  her  to  a  sitting  position;  lift  her  from  the  bed; 
carry  her. 

u 


Contents 


CHAPTER   III 

PAGE 

BED-MAKING 46 

Important  points  to  be  considered  when  stripping 
and  making  a  bed.  Demonstration  3:  Stripping  a 
bed  and  making  a  closed  bed.  Demonstration  4: 
Making  a  bed  with  the  patient  in  it,  including  chang- 
ing the  nightgown  and  turning  the  pillows. 

CHAPTER   IV 

PREPARATION  OF  A  PATIENT  FOR  THE  NIGHT        59 

Demonstration  5:  Preparation  of  a  patient  for  the 
night,  including  rubbing  the  back,  cleaning  the  teeth, 
and  doing  the  hair.  How  to  give  and  remove  a  bed- 
pan. 

CHAPTER  V 

ESSENTIALS  FOR  A  PATIENT'S  COMFORT  .      66 

Principles  involved  in  making  a  patient  comfort- 
able under  varying  conditions,  including  when  she  is 
out  of  doors  in  cold  weather.  Causes  and  prevention 
of  pressure  sores  and  chafing.  Demonstration  6: 
Methods  of  making  a  patient  comfortable  when:  (i) 
Lying  in  different  positions;  (2)  sitting  up  in  bed. 
Demonstration  7:  Preparing  a  patient  to  get  out  of 
bed  and  making  her  comfortable  in  a  chair. 

CHAPTER  VI 

BATHS.    CARE  OF  THE  HAIR.         ...      90 

Purposes  of  baths.  Effects  of  cold,  hot,  and  tepid 
baths  and  how  they  produce  these  effects.  What  is 
meant  by  muscle  tone,  Reasons  for  the  necessity  of 
cleansing  baths.  Demonstration  8:  Giving  a  cleans- 
ing bath  to  a  person  in  bed.  Care  of  the  hair.  De- 
monstration 9:  Cleaning  the  hair.  Demonstration 
10:  Washing  the  hair.  Demonstration  n:  Methods 
of  giving  foot  baths. 


Contents  xi 

CHAPTER  VII 

PACE 

TEMPERATURE.     PULSE.     RESPIRATION.     RE- 
CORDS   ...  .     116 

Heat  production,  elimination,  and  regulation. 
Fever.  Nature  and  care  of  thermometers.  Demon- 
stration 12:  Procedure  in  taking  the  temperature. 
The  nature  of  the  pulse.  Conditions  that  cause 
changes  in  the  rate  and  character  of  the  pulse.  The 
nature  of  respiration  and  of  breathing.  Factors 
controlling  these  functions.  Demonstration  13: 
Counting  the  pulse  and  breathing.  Some  important 
reasons  for  keeping  records  of  a  patient's  condition. 
Nature  of  records. 

CHAPTER  VIII 

MEDICATION.    EXTERNAL    APPLICATIONS.     IR- 
RIGATIONS      .  ...     139 

Method  of  administering  drugs.  Bad  effects 
that  may  arise  from  the  unadvisable  use  of  drugs. 
Important  points  to  be  remembered  regarding  the 
care  and  administration  of  drugs.  Measuring  medi- 
cines. Application  of  medication  to  the  nose,  throat, 
ears,  eyes,  and  skin.  Demonstrations  14  to  21,  in- 
cluding: Measuring  medicines;  application  of  medi- 
cation to  the  throat  and  steam  inhalations;  irrigation 
of  the  ear;  application  of  medicine  to  the  eyes;  mak- 
ing poultices  and  sinapisms;  applying  ointment,  lini- 
ments, iodine,  fomentations,  hot-water  bags  and 
substitutes,  ice-caps  and  substitutes.  The  nature 
and  uses  of  counter-irritants. 

CHAPTER   IX 

CARE  OF  CHILDREN       .....     196 

Normal  development  of  children  and  measures  to 
promote  it.  Some  especially  important  facts  regard- 
ing mental  development.  Requirements  for  health. 


xii  Contents 

PAGE 

Method  of  taking  a  baby's  temperature.  Suitable 
clothing  for  an  infant.  Care  of  diapers.  Demon- 
stration 22:  Lifting,  weighing  and  dressing  a  baby. 
Reasons  for  the  modification  of  milk.  Care  necessary 
in  the  preparation  of  an  infant's  food  and  in  its  feed- 
ing. Care  of  feeding  bottles  and  nipples.  Demon- 
stration 23:  Preparation  of  an  infant's  food  and  the 
care  of  utensils  required  for  the  purpose. 

CHAPTER  X 

BANDAGING .241 

Uses,  kinds  and  sizes  of  bandages.  How  to  make 
bandages.  Points  to  remember  when  bandaging. 
Demonstration  24:  Circular,  spiral,  spiral  reverse, 
and  figure-eight  bandages.  Bandages  for  the  leg, 
foot,  heel,  knee,  arm,  fingers,  shoulder.  Tailed  and 
handkerchief  bandages  and  slings. 

PART  II 

CHAPTER    XI 

FIRST    AID    TREATMENT    IN    ACCIDENT    AND 

OTHER  EMERGENCIES       ....     257 

The  principles  of  first  aid  treatment.  Nature, 
causes  and  first  aid  treatment  of:  Unconsciousness; 
fainting  or  syncope;  hysteria;  sunstroke;  heat  pros- 
tration; convulsions;  chills.  Demonstration  25: 
First  aid  treatment  in  the  above  emergencies,  includ- 
ing lifting  and  carrying  an  unconscious  patient  who 
has  fallen  to  the  ground. 

CHAPTER  XII 

ASPHYXIA       OR       SUFFOCATION.    ARTIFICIAL 

RESPIRATION  ......     279 

Mechanism  of  breathing.     Nature,  common  causes 
and    treatment    of    asphyxia.     Demonstration    26. 


Contents  xiii 


Artificial  respiration  and  treatment  of  an  individual 
rescued  from  drowning. 

CHAPTER  XIII 
WOUNDS 287 

The  nature,  classification,  means  of  repair,  and 
common  complications  of  wounds.  Causes  of,  and 
means  of  preventing,  the  infection  of  wounds.  First 
aid  treatment  of  wounds.  Demonstration  27: 
Dressing  a  wound. 

CHAPTER  XIV 

FRACTURES.     DISLOCATIONS.    SPRAINS.    HEM- 
ORRHAGE       ....  .     304 

Nature  of  fractures.  How  bone  is  repaired. 
Symptoms  and  first  aid  treatment  of  fractures. 
Nature,  symptoms,  and  treatment  of  dislocations 
and  sprains.  Nature  and  symptoms  of  hemorrhage. 
Natural  resources  of  the  body  for  arresting  hemor- 
rhage. First  aid  treatment  of  hemorrhage.  Demon- 
stration 28:  First  aid  treatment  of  fractures  and 
hemorrhage. 

CHAPTER   XV 

FIRE.    BURNS.    SCALDS.     FROST-BITE.    CHIL- 
BLAIN    .  321 

How  to  put  out  fires.  How  to  escape  and  help 
others  escape  from  burning  buildings.  Demon- 
stration 29:  Extinguishing  flames  from  the  clothing 
and  use  of  fire  extinguishers.  Various  causes  and 
treatments  of  burns.  Treatment  of  scalds.  Nature, 
causes,  and  treatment  of  frost-bite  and  chilblain. 
Other  consequences  of  exposure  to  cold. 


xiv  Contents 

CHAPTER  XVI 

PAGE 

REMOVAL  OF   FOREIGN   BODIES  AND  TREAT- 
MENT OF  POISONING        .        .        .        .331 

Methods  of  removing  foreign  bodies  from  the  eye, 
ear,  nose,  throat,  bronchial  tubes,  and  alimentary 
canal.  Nature  of  poisoning  and  the  first  aid  treat- 
ment for  poisoning  by  some  of  the  more  common 
poisons. 

GLOSSARY         ......    349 

INDEX 355 

INDEX  OF  DEMONSTRATIONS        .         .         .    359 


A  Textbook  of 

Simple  Nursing  Procedure 

For  Use  in  High  Schools 


A  Text- Book  of  Methods 
of  Nursing 


EQUIPMENT   FOR   DEMONSTRATION  ROOM 

If  possible  the  room  in  which  nursing  procedures 
are  demonstrated  should  be  furnished  as  a  bedroom 
and  there  should  be  a  sufficiently  large  cupboard 
in  it  to  hold  the  articles  other  than  the  furniture 
required  for  the  demonstrations.  If  it  is  not  prac- 
ticable to  have  all  the  furnishings  of  a  bedroom 
there  should  be  at  least:  A  bed,  see  page  8; 
a  screen ;  2  tables,  one  of  which  should  be  a  small 
one  to  stand  at  the  bedside  and  the  other  a  fairly 
large  one  on  which  to  place  the  equipments  re- 
quired for  a  day's  demonstration;  it  is  also  well  if 
possible  to  have  an  adjustable  invalid's  table; 
2  chairs,  one  of  which  should  be  suitable  for  Dem- 
onstration 6  and  the  other  for  Demonstration  7, 
see  Figs.  15  and  22. 

Bedding:  I  mattress,  5  pillows,  6  sheets,  6 
pillow  cases,  2  bed  blankets,  I  colored  blanket  and 
I  cotton  bath  blanket,  2  spreads,  a  bed  pad  large 
enough  to  cover,  the  mattress,  a  piece  of  rubber 
sheeting  about  I  yard  wide  and  i^  yards  long. 


2  Nursing  Methods 

As  far  as  possible  the  bedding  should  correspond 
with  the  description  given  on  page  9. 

Two  nightgowns,  a  kimono  or  wrapper,  and  a 
shoulder  wrap. 

Two  or  3  bath  towels  and  about  6  hand  towels 
and  washcloths. 

Toilet  articles  including:  A  toilet  basin  and 
pitcher,  toothbrush  and  holder,  glass,  a  small  bowl, 
soap  and  nailbrush  in  appropriate  dishes,  orange 
stick,  scissors,  and  nail  file. 

A  fountain  syringe  bag,  or  else  an  irrigator  with 
tubing  attached. 

A  rubber  air-ring,  if  possible. 

An  ear  bulb  syringe,  a  return  flow  aural  tip  and 
an  atomizer. 

A  hot-water  bag  and  quart  bottles  with  corks  to 
be  used  as  substitutes. 

An  ice-cap  and  a  pick  and  mallet  for  breaking  ice. 

A  bedpan  and  cover.  If  the  pan  is  not  provided 
with  a  cover  one  can  be  made  of  heavy  washable 
material  or  double-faced  rubber  sheeting. 

Sputum  cups,  both  porcelain  or  enamel  and 
paper  varieties. 

A  bath  thermometer,  an  atmospheric  thermome- 
ter and  clinical  thermometers,  if  possible  one  for 
each  pupil,  a  tall  glass  to  hold  a  disinfectant  for  the 
thermometers. 

A  foot-tub  or  baby's  bath. 

Scales  for  weighing  baby. 

Two  enamel  trays,  one  about  14  by  20  inches 
and  the  other  about  6  by  9  inches. 


Demonstration  Room  Equipment  3 

A  croup  kettle  or  a  substitute  as  described,  page 


An  electric  or  gas  stove. 

A  flatiron. 

An  asbestos  mat. 

A  saucepan  with  a  capacity  of  about  I  quart. 

An  agate  basin  with  a  capacity  of  at  least  i 
quart. 

A  measuring  cup,  teaspoon,  tablespoon,  knife, 
and  spatula. 

Two  wooden  boxes  arranged  as  described  on  page 
78,  and,  if  possible,  a  bed-cradle,  back-rest,  and 
Meirinecke  non-slipping  knee  and  thigh  support. 

A  first  aid  box1  containing:  Small  packages  of 
sterile  gauze  and  absorbent  cotton,  adhesive  plaster, 
bandages,  a  pair  of  scissors  and  a  pair  of  forceps 
and  a  small  deep  dish  to  sterilize  these  in  (a  deep 
agate  soap  dish  will  answer),  a  small  bowl  ;  a  medi- 
cine glass,  a  small  nailbrush,  orange  sticks,  some 
small  pieces  of  soft,  clean  muslin,  boric  acid  powder, 
small  bottles  containing  a  3  per  cent,  dilution  of 
tincture  of  iodine,2  denatured  alcohol,3  liquid 
green  soap,  lysol  or  other  disinfectant.  A  bundle 
of  wooden  tongue  depressors. 

1  Either  a  metal  box  or  a  wooden  one  lined  with  wax  paper 
will  be  the  best.  The  box  should  be  locked. 

3  The  official  tincture  of  iodine  is  7  per  cent.,  but  this  is  irritant, 
especially  for  children,  and  a  3  per  cent,  solution  is  an  adequate 
disinfectant  for  the  skin.  The  dilution  should  be  done  by  the 
druggist  as  pure  alcohol  must  be  used. 

3  Alcohol  to  which^a  poison  is  added  that  renders  it  unfit  for 
drinking  but  does  not  interfere  with  its  value  for  external  use. 


4  Nursing  Methods 

Red  Cross  emergency  charts. 

A  small  bandage  roller  if  possible. 

Bandages,  2}^  and  3  inches  wide,  about  3  for 
each  pupil,  or  the  material  to  make  the  bandages. 

A  ball  of  heavy  white  twine. 

Paper  bags  of  different  sizes  and  a  number  of 
newspapers. 

Pieces  of  old  muslin,  cheesecloth,  flannel  and 
flannelet. 

Mustard,  flour,  linseed,  and  antiphlogistine. 

Cleaning  utensils,  including:  Dusters  of  cheese- 
cloth and  suitable  pieces  of  old  muslin;  dustless 
dusters;  an  o'cedar  mop;  a  broom,  whisk,  dustpan, 
if  possible  a  carpet  sweeper  and  vacuum  cleaner;  a 
small  scrubbing  brush,  a  twig  sink  brush  and  a  jar 
in  which  it  can  be  kept,  a  small  agate  pail,  a  can  of 
bon  ami,  soap  and  a  dish  to  keep  it  in. 

A  board  about  9  inches  wide  and  as  long  as  the 
width  of  the  window  in  the  classroom  as  shown  in 
Fig.  2,  on  page  21. 

A  large  and  a  small  demonstration  doll. 

Baby's  clothes. 

Feeding  bottles,  a  basket  to  keep  them  in,  and  a 
pot  large  enough  to  hold  the  basket  of  bottles. 

Nipples  in  a  glass  jar. 

A  brush  for  cleaning  the  bottles.  For  descrip- 
tion of  these  articles  see  page  227. 

A  number  of  the  articles  in  the  foregoing  list  are 
required  for  only  one  or  two  demonstrations  and, 
in  some  cases,  demonstrations  that  are  likely  to  be 
omitted  if  there  is  not  time  to  have  all  those  de- 


Demonstration  Room  Equipment  5 

scribed  in  this  volume.  However,  on  the  first  page 
of  each  chapter  there  will  be  found  either  a  list  of 
the  equipment  required  for  the  demonstrations 
described  in  the  Chapter  or  else  the  number  of  the 
pages  on  which  the  lists  are  given.  Thus  it  will 
be  an  easy  matter  for  those  choosing  classroom 
equipments  to  eliminate  unnecessary  articles. 


CHAPTER  I 

Care  of  the  Sick-Room  and  of  Utensils  Com- 
monly Employed  in  the  Treatment  of  the 
Sick 

Articles  required  for  Demonstration  i.  Ideal  location  and 
characteristics  of  a  sick-room.  Suitable  furnishings  for  a  sick- 
room. The  natural  phenomena  upon  which  ventilation  and  the 
purification  of  the  air  depend.  The  reasons  for  the  unpleasant 
effects  experienced  when  in  a  poorly  ventilated  room.  Some 
methods  of  ventilation.  Why  cleanliness  is  necessary  to  prevent 
the  transmission  of  disease  and  the  ways  in  which  some  of  the 
more  common  communicable  diseases  are  transmitted.  Impor- 
tant rules  to  observe  when  sweeping  and  dusting.  Methods  of 
cleaning  and  disinfecting  utensils  commonly  used  in  the  care  of 
'the  sick.  Demonstration  i. 

Equipment  for  Demonstration  i ' : 

The  entire  equipment  should  be  on  view.  The 
articles  especially  required  are : 

The  window  board. 

Cleaning  utensils. 

Articles  that  need  special  attention  when  they 
are  cleaned,  as  the  bedpan,  hot-water  bag,  ice-cap, 
and  rubber  tubing. 

The  procedure  of  this  demonstration  is  to  consist 

1  The  furniture  mentioned  on  page  i,  is  not  listed  with  the 
equipment  for  the  demonstrations  because  it  is  supposed  to  be 
always  present. 

6 


Care  of  Sick-Room  and  Utensils    7 

of  an  exposition  of  methods  of  ventilation,  sweep- 
ing and  dusting,  and  cleaning  utensils. 

Desirable  Characteristics  of  a  Sick-Room  and  its 
Furnishings 

A  room  in  which  a  sick  person  is  confined  should 
be  quiet,  bright,  and  as  attractive  as  possible.  A 
room  with  a  southern  exposure,  that  has  at  least 
two  windows  and  a  hard  wood  paraffined  floor, 
that  is  near  a  bathroom  and  removed  from  the 
noises  of  the  street  and  house  is  the  ideal. 

If  the  patient  is  likely  to  be  ill  for  any  length  of 
time,  heavy  curtains  that  interfere  with  ventila- 
tion and  superfluous  ornaments  that  make  it 
difficult  to  keep  the  room  clean  should,  if  present, 
be  removed,  but  the  room  must  not  be  allowed  to 
have  a  bare  appearance  and  medicine  bottles  and 
utensils  suggestive  of  illness  are  to  be  kept  out  of 
sight,  out  of  the  room  if  possible.  Growing  plants 
are  valuable  ornaments  in  a  sick-room  because 
they  not  only  help  to  make  it  look  pretty  and 
bright,  but,  as  explained  later,  during  the  day- 
time, they  give  off  oxygen  and  absorb  carbon  dioxid 
and  thus  they  help  to  keep  the  air  in  the  room  pure. 
In  steam-heated  rooms  water  flowers  growing  in 
open  bowls  are  particularly  good,  because,  as  the 
water  evaporates,  it  helps  to  prevent  the  air  be- 
coming too  dry. 

It  is  not  advisable  to  use  expensive  bedspreads, 
blankets,  and  the  like  on  the  bed  of  a  very  sick 


8 


Nursing  Methods 


patient,  nor  to  have  a  valuable  rug  or  table  near 
the  bed,  especially  if  the  patient  is  receiving  much 
treatment,  because,  under  such  circumstances 
there  are  many  chances  of  accidents,  even  if  those 
caring  for  the  patient  are  particularly  careful. 

A  suitable  bed  and  bedding  are  of  great  impor- 
tance to  a  patient's  comfort.    The  ideal  bed  is  one 

with  an  iron  frame 
(which  is  easily  kept 
clean)  and  a  good  wire 
spring,  that  is  about 
twenty-four  inches 
high,  thirty-six  inches 
wide  and,  for  an  adult, 
a  little  over  six  feet  in 
length.  If  the  bed 
is  much  lower  than 
twenty -four  inches  it 
makes  it  difficult  to  move  the  patient  easily.  Of 
course  when  the  patient  is  able  to  move  without 
much  assistance  and  the  illness  is  of  a  transitory 
nature,  this  may  not  be  of  much  importance,  but, 
when  the  patient  is  suffering  from  a  chronic  disease 
and  requires  considerable  assistance,  the  height  of 
the  bed  is  of  so  much  importance  for  the  comfort 
both  of  the  patient  and  those  caring  for  her  that,  if 
a  bed  about  the  required  height  cannot  be  obtained, 
it  is  well  to  get  four  wooden  blocks  of  sufficient  size 
to  raise  the  bed  to  the  required  height ;  in  the  center 
of  each  block,  there  should  be  a  hole  about  two 
inches  deep  into  which  the  legs  of  the  bed  will  fit. 


Fig.  i.  Ideal  bed  for  an  invalid's 
use.  The  back-rest  can  be  lowered  and 
raised  as  desired. 


Care  of  Sick-Room  and  Utensils    9 

The  mattress  should  be  about  two  inches  shorter 
than  the  bed.  Hair,  Ostermoor  felt,  and  silk  floss 
are  generally  considered  to  be  the  best  fillings  for 
mattresses.  Even  mattresses  with  cheaper  fillings 
than  these  are  expensive  and,  therefore,  the 
mattress  should  be  covered  with  a  protector.  The 
most  comfortable  kind  of  a  protector  is  a  quilted 
pad,  such  as  is  used  to  protect  the  mattress  in  a 
baby's  crib,  but,  if  the  patient  has  to  use  the  bed- 
pan and  is  at  all  helpless,  it  is  advisable  to  have  a 
rubber  protector  also.  In  emergency  pieces  of  old 
blanket  or  newspapers  sewn  to  a  muslin  foundation 
can  be  substituted.  The  sheets  should  be  about  a 
yard  longer  and  a  yard  wider  than  the  mattress. 
The  spread  should  be  of  light  weight  material  for 
the  weight  of  those  of  heavy  material  is  quite  out 
of  proportion  to  the  degree  of  warmth  which  they 
provide. 

The  location  of  the  bed  is  often  of  importance. 
The  points  to  be  considered  being:  (i)  That  it  is  far 
enough  away  from  the  walls  to  make  it  unnecessary 
to  move  it  when  making  the  bed  or  when  doing 
anything  for  the  patient ;  (2)  that  it  is  in  the  right 
position  with  regard  to  the  window.  What  the 
right  position  will  be  depends  somewhat  upon  the 
patient's  condition,  a  person  who  is  not  very  ill  is 
likely  to  want  to  look  out  of  the  window,  but,  if  the 
patient  is  very  ill,  the  points  to  be  considered  are: 
(i)  To  have  the  bed  where  it  will  not  be  in  a  draft 
— for  example,  between  the  window  that  will  be 
opened  for  ventilation  and  the  door;  (2)  where  the 


io  Nursing  Methods 

light  will  not  shine  in  the  patient's  eyes.  This  is 
very  important,  because  except  in  diseases  that 
affect  the  eyes  or  the  brain,  or  when  the  patient 
wants  to  rest,  it  is  usually  desirable  to  have  as 
much  sunlight  as  possible  enter  the  sick-room,  both 
because  it  helps  to  make  it  cheerful  and  because 
sunlight  is  an  excellent  disinfectant,  that  is,  it  will 
destroy  bacteria.  If  the  bed  cannot  be  placed 
where  the  light  will  not  annoy  the  patient  a  screen 
should  be  put  between  it  and  the  window. 

Care  of  the  Sick-Room 

Care  of  the  sick-room  involves  attention  to  its 
ventilation,  temperature,  and  cleanliness. 

Ventilation 

Ventilation  has  been  defined  as  the  continuous 
introduction  of  pure  air  into  a  room  or  building, 
thoroughly  mixing  it  with  the  contained  air  and  the 
simultaneous  extraction  of  a  like  quantity  of  impure 
air.1 

Before  considering  the  methods  of  ventilation 
it  will  be  well  to  recall:  (i)  The  nature  and  com- 
position of  the  air;  (2)  the  sources  of  its  impurities; 
(3)  nature's  methods  of  purifying  the  air;  (4)  the 
cause  of  winds  and  drafts ;  (5)  the  nature  and  cause 
of  humidity;  (6)  the  reason  for  the  discomfort 
experienced  in  badly  ventilated  rooms;  (7)  the 
causes  of  odors  in  badly  ventilated  rooms. 

1  Principles  of  Hygiene.    Bergy,     W.  B.  Saunders  Co. 


Care  of  Sick-Room  and  Utensils  n 

Air  is  a  colorless,  odorless,  transparent  mixture 
of  gaseous  elements.  When  pure,  it  consists  of 
approximately,  nitrogen  79  parts;  oxygen  20.96 
parts;  carbon  dioxid,  0.04  parts;  small  amounts  of 
other  gases  such  as  argon  and  ozone  and  a  varying 
amount  of  aqueous  vapor. 

The  impurities  in  the  air  are  both  gaseous  and 
solid.  The  most  common  gaseous  impurities  are: 
(i)  Those  arising  from  the  combustion  taking 
place  in  stoves,  furnaces,  and  the  like;  (2)  those 
due  to  the  oxidation  going  on  in  the  bodies  of  all 
animals  and  given  off  through  the  respiratory 
organs;  (3)  those  produced  during  the  decomposi- 
tion of  animal  and  vegetable  matter.  Ordinarily, 
this  gaseous  matter  is  chiefly  carbon  dioxid,  with 
possibly  some  sulphur  and  ammonia  compounds, 
and  unless  present  in  excess  it  is  not  injurious  to 
health,  but,  in  localities  where  there  are  defective 
sewer  pipes  or  where  there  are  factories  or  much 
decaying  vegetable  or  animal  matter,  there  may 
be  other  gases  present  some  of  which,  if  continu- 
ously inhaled,  may  cause  destruction  of  the  red 
corpuscles  in  the  blood  or  otherwise  affect  the 
body  in  a  manner  that  lessens  its  resistant  powers 
to  bacteria  and  other  causes  of  disease. 

The  more  common  solid  impurities  in  the  air  are : 
Sand,  dust,  soot,  products  of  street  refuse,  micro- 
organisms, the  pollen  of  plants,  and  where  there 
are  factories  and  the  like  there  may  be  substances 
derived  from  material  worked  upon  in  the  build- 
ings. 


12  Nursing  Methods 

In  many  industries  the  impurities,  either  gaseous 
or  solids,  are  particularly  injurious  and,  unless 
adequate  protective  measures  are  taken,  may 
undermine  the  health  of  the  workers.  Impurities 
of  this  kind  are  known  as  industrial  or  occupational 
poisons. 

The  air  is  kept  pure  by  rain,  plant  life,  and  the  air 
currents  known  as  winds  and  breezes. 

The  rain  helps  to  purify  the  air  by  beating  down 
the  solid  impurities  and  by  absorbing  the  gaseous 
and  carrying  them  down  into  the  ground. 

Plants  help  to  purify  the  air  by :  (i)  Taking  the 
carbon  dioxid  (CO2)  and  using  it,  with  salts  and 
water  (H  2  O),  which  they  abstract  from  the  ground, 
to  form  their  substance;  (2)  liberating  oxygen. 
Plants  set  oxygen  free  because  the  compounds  of 
which  they  consist  contain  less  oxygen  than  they 
absorb  as  CO2  and  H2O  and,  as  the  chemical  re- 
actions upon  which  their  growth  depends  proceed, 
the  oxygen  is  set  free  and  passes  into  the  air.  This 
is  practically  the  only  source  of  the  world's  supply 
of  oxygen.  The  chemical  reactions  are  activated 
by  chlorophyl  (the  green  coloring  matter  of  plants) 
and  light  and  they  take  place  only  in  light  and  thus 
oxygen  is  not  set  free  from  plants  in  the  dark. 

Cut  plants  do  not  liberate  oxygen;  on  the  con- 
trary, once  they  begin  to  fade,  they  absorb  oxygen 
and  give  off  COa. 

The  origin  of  winds:  Heat  causes  all  matter, 
including  the  air,  to  expand  and  cold  makes  matter 
contract.  Therefore,  in  proportion  to  its  bulk,  hot 


Care  of  Sick-Room  and  Utensils  13 

air  is  lighter  than  cold  air  and  will  rise,  but,  being 
expanded  and  lighter,  it  will  not  exert  as  much 
pressure  as  cold  air.  When  the  atmospheric  (air) 
pressure  in  any  locality  is  reduced  in  this  way,  air 
from  colder  regions  is,  as  it  were,  pressed  forward, 
this  creates  the  air  currents  known  as  winds  and 
breezes.  The  greater  the  differences  between  the 
temperatures  of  the  air  in  different  regions,  the 
stronger  will  be  the  air  currents,  thus  they  may  be 
so  slight  that  they  will  be  hardly  perceived  or  so 
violent  that  they  constitute  a  hurricane.  Even  the 
difference  in  the  temperature  of  the  air  in  the 
shade  and  in  the  direct  sunlight  is  sufficient  to 
maintain  movement  of  the  air. 

In  the  natural  ventilation  of  rooms  the  same 
forces  are  depended  upon  to  change  the  air  as  out 
of  doors.  The  air  around  the  radiators,  stove,  or 
open  fire  becomes  heated,  expands,  spreads  through 
the  room,  especially  upward,  some  of  the  colder 
air  then  comes  nearer  the  source  of  heat,  becomes 
heated,  and  so  on.  As  the  heated  air  expands  it 
forces  its  way  through  the  crevices  around  windows 
and  doors  and  therefore  the  amount  of  air  within 
the  room  is  soon  reduced  and  there  is  not  enough 
to  oppose  the  weight  of  the  air  on  the  outside  of  the 
windows  and  doors  which  is  therefore  pressed  into 
the  room.  The  greater  the  difference  between  the 
temperature  out  of  doors  and  in  doors,  the  more 
rapid  will  be  the  interchange  of  air ;  therefore,  on  a 
cold  day,  a  very  small  opening  will  afford  as  much 
ventilation  as  a  wide-open  window  on  a  hot  day.  If 


14  Nursing  Methods 

there  is  much  difference  between  the  incoming  air 
and  that  out  of  doors  the  movement  of  air  may  be 
perceived  and  it  is  then  called  a  draft  A  draft  is 
particularly  likely  to  occur  when  two  openings  are 
directly  opposite  to  each  other. 

A  fire,  or  even  a  lighted  lamp,  in  an  open  fire- 
place affords  an  excellent  means  of  ventilating  a 
room  in  cold  weather,  because,  as  the  air  in  the 
chimney,  becomes  heated,  it  passes  upward  and  out, 
and  thus  there  is  soon  a  partial  vacuum  in  the 
chimney  and  air  from  the  room  and  also,  to  an 
even  greater  extent,  from  outside  is  pressed  into  it. 
The  air  from  the  room  being  warmer  than  that 
coming  down  the  chimney,  and  coming  first  in 
contact  with  the  fire,  rises  while  most  of  that  from 
outside  passes  into  the  room.  If,  when  the  fire  is 
lighted,  the  air  in  the  chimney  is  much  colder  than 
that  in  the  room  it,  and  with  it  the  smoke,  will  be 
forced  into  the  room.  This  can  be  prevented  by, 
before  lighting  the  fire,  holding  a  piece-  of  burning 
paper  a  little  way  up  the  chimney  flue. 

To  summarize:  Ventilation  is  maintained  by 
inducing  currents  of  air  and,  in  natural  ventilation, 
the  currents  are  produced  by  differences  in  tem- 
perature, because  hot  air  diffuses  rapidly  and  rises 
while  cold  air  falls. 

In  what  is  known  as  artificial  ventilation  the  air 
is  kept  in  motion  by  various  mechanical  devices, 
such  as  fans  and  pumps,  which,  as  a  rule,  are  situ- 
ated in  chimney -like  passages  that  communicate 
with  the  rooms  by  means  of  ventilators. 


Care  of  Sick- Room  and  Utensils  15 

By  humidity  is  meant  the  aqueous  (water)  vapor 
in  the  air.  It  is  derived,  as  the  result  of  evapora- 
tion, from  oceans,  rivers,  and  other  bodies  of  water, 
and  from  the  moisture  on  the  ground  after  rain. 
The  evaporation  is  induced  by  heat.  In  other 
words,  heat  changes  the  liquid  water  to  vapor  and 
the  vapor,  being  of  a  gaseous  nature  and  lighter 
than  air,  rises  and  spreads  through  the  atmosphere. 

Localities  in  which  there  are  no  large  bodies  of 
water  will  have  a  relatively  low  degree  of  humidity, 
but,  even  in  such  places,  there  will  be  some  water 
vapor  for  it  will  be  driven  thither  by  the  winds. 
In  cities,  that  are  near  large  bodies  of  water  and 
where  the  buildings  are  high,  the  humidity  is 
likely  to  become  excessive  on  hot  days,  because 
the  high  buildings  interfere  with  the  passage  of  air 
currents  and,  consequently,  with  the  escape  of  the 
extra  vapor  that  the  heat  induces.  This  will  occur 
also  in  badly  ventilated  rooms  in  which  there  are 
several  people  because  the  perspiration,  which  is 
being  constantly  secreted  by  the  sweat  glands  in 
the  skin,1  is  evaporated  and  the  vapor  passes  into 
the  air.  When  there  is  a  lack  of  air  movement 
in  a  room  the  vapor  resulting  from  the  evaporation 
of  sweat  is  not  driven  away  from  around  the  body 

'Usually,  at  ordinary  room  temperatures  about  a  quart  of 
water  is  excreted  through  the  sweat  glands  in  twenty-four  hours, 
but,  in  a  hot  environment,  a  very  much  larger  amount  will  be 
excreted.  We  are  not,  as  a  rule,  conscious  of  this  excretion,  be- 
cause it  is  evaporated  as  soon  as  it  flows  to  the  surface  of  the  skin, 
but  we  feel  and  see  it  When  it  becomes  excessive  or  if  its  evapora- 
tion is  interfered  with. 


16  Nursing  Methods 

and  this  interferes  with  further  evaporation,  be- 
cause the  air  will  only  take  up  a  certain  amount 
of  moisture. x 

It  is  now  believed  that  the  sense  of  discomfort 
that  one  experiences  in  a  badly  ventilated  room 
is  due  chiefly  to  the  results  of  this  interference  with 
evaporation  and  not,  as  was  formerly  supposed,  to 

1  The  air  will  only  hold  definite  amounts  of  moisture,  how  much 
depending  upon  the  temperature;  for  example,  a  cubic  foot  of  air 
will  hold: 

1.32  grams  of  moisture  at  20°  F. 

2.1 1      "       "        "        "   32°  P. 

2.84      "       "        "        "  40°  F. 

5.74      "      "        "        "   6o«F. 

10.93      "      "        "        "   80°  F. 

14.79      "      "        "        "   90°  F. 

Out  of  doors,  even  before  saturation  occurs  if  the  weather 
becomes  cooler,  the  vapor  begins  to  condense.  If  it  appears  on 
the  ground,  it  is  called  dew;  if  it  condenses  on  dust  particles,  in 
small  amounts  and  near  the  ground,  it  is  called  mist;  if  in  larger 
amounts,  fog;  if  high  in  the  air,  cloud.  Unless  a  large  amount  of 
water  vapor  becomes  condensed,  the  minute  droplets  are  lighter 
than  the  air  and  are  wafted  about  with  the  air  currents,  but  if 
large  amounts  of  moisture  condense  in  the  clouds,  the  particles  of 
water  become  heavier  than  the  air  and  fall  to  the  earth  as  rain  or, 
if  the  rain  comes  in  contact  with  cold  currents  while  falling,  hail, 
or,  if  the  atmosphere  around  the  clouds  is  below  freezing  point, 
snow.  When  the  actual  amount  of  vapor  in  a  given  amount  of  air 
is  stated  in  weight,  as  in  the  above  table,  it  is  termed  the  absolute 
humidity,  but  when  the  degree  of  humidity  is  expressed  in  per- 
centage it  is  spoken  of  as  the  relative  humidity,  and  the  amount  of 
moisture  that  the  air  will  hold,  i.e.,  when  the  air  is  saturated,  is 
called  100  per  cent.  The  most  desirable  degree  of  humidity  is 
between  60  and  70  per  cents.  If  there  is  too  little  moisture  in  the 
air,  evaporation  of  moisture  from  the  surface  of  the  body  goes  on 
too  freely  and  the  skin  and  the  membranes  covering  the  eyes  and 
lining  the  nose,  mouth,  throat  become  abnormally  dry. 


Care  of  Sick-Room  and  Utensils  17 

the  carbon  dioxid  that  collects  nor  to  the  lessened 
mount  of  oxygen1  because  experiments  have 
shown  that  in  rooms  as  they  are  ordinarily  built, 
there  is  too  much  interchange  of  air  through  the 
cracks  around  windows  and  doors  to  allow  of  the 
carbon  dioxid  reaching  a  poisonous  concentration 
or  of  the  oxygen  becoming  sufficiently  reduced  to 
account  for  the  effects.  Also,  it  has  been  found 
that  if  the  air  is  kept  in  motion  by  means  of  a  fan 
a  greater  degree  of  air  vitiation  can  be  borne  with- 
out discomfort  than  when  the  air  is  still  and,  of 
course,  the  movement  of  the  air  drives  away  the 
humid  air  around  the  body.  If  the  air  in  the  room 
is  hot,  the  effects  of  bad  ventilation  will  be  more 
keenly  felt,  because  the  loss  of  heat  from  the  body 
by  radiation2  will  be  interfered  with. 

The  results  of  the  interference  with  evaporation 
are  as  follows :  The  skin  becomes  moist  and  warm, 
the  superficial  blood-vessels  dilate  and,  conse- 
quently, a  larger  amount  of  blood  flows  to  the  skin 
(this  is  shown  by  its  red  color)  and  the  quantity  of 
blood  in  the  internal  organs,  especially  the  brain,  is 
therefore  diminished.  As  the  result  of  the  reduc- 

1  As  we  breathe  we  take  oxygen  away  from  the  air  and  if  gas  is 
burning  or  there  is  fire  in  a  stove,  etc.,  oxygen  is  taken  to  maintain 
the  burning,  because  burning,  or,  as  it  is  sometimes  called  com- 
bustion or,  when  it  goes  on  slowly,  as  in  the  human  body,  oxida- 
tion consists  in  the  union  of  oxygen  with  matter.    When  oxygen 
unites  with  compounds  they  are  decomposed  and  heat  is  produced. 

2  Space  will  not  permit  description  of  radiation  further  than  to 
state  that  it  is  one  of  the  ways  in  which  heat  passes  from  hot 
matter,  the  term  is  used  because  what  is  called  heat  passes  outward 
from  the  body  in  which  it  originates  in  straight  lines  or  rays. 


1 8  Nursing  Methods 

tion  of  the  brain's  blood  supply  a  sensation  of 
drowsiness  and  inability  to  fix  the  attention  are 
experienced  and,  especially  if  one  tries  by  volun- 
tary effort  to  overcome  the  inattention,  headache 
is  likely  to  result.  When  the  atmosphere,  either 
in  doors  or  out  of  doors,  is  both  hot  and  humid  the 
body  temperature  may  rise  to  a  degree  that  is  in- 
compatible with  life.  Such  a  condition  is  known  as 
heat  prostration  and  as  sun-stroke. 

The  reason  for  the  heating  of  the  skin  and  the 
rise  of  body  temperature  is  that  the  heat  which  is 
formed  in  the  body  by  the  oxidation  of  material 
derived  from  food  is  not  gotten  rid  of  when  radia- 
tion and  the  evaporation  of  sweat  are  interfered 
with,  for  these  are  the  two  ways  in  which  most  of 
the  heat  is  lost  from  the  body.  Heat  is  lost  by 
evaporation  of  sweat  because  evaporation  is  only 
brought  about  by  heat  and  that  required  is  taken 
from  the  body.  Heat  radiates  from  the  body  in  the 
same  manner  as  it  does  from  a  stove  or  any  other 
heated  object. 

As  the  conditions  in  a  badly  ventilated  room 
interfere  with  the  circulation  of  the  blood,  it  can  be 
readily  appreciated  that  people  who  spend  much 
of  their  time  in  places  where  the  ventilation  is 
defective  are  not  likely  to  be  really  healthy  and 
they  become  very  susceptible  to  changes  in  tem- 
perature and  "take  cold  easily." 

The  odor  commonly  perceived  in  a  badly  ven- 
tilated room  is  not,  as  is  commonly  supposed,  due 
to  carbon  dioxid,  for  CO2  is  odorless.  Ordinarily, 


Care  of  Sick-Room  and  Utensils  19 

it  is  from  the  sebaceous1  matter  and  perspiration 
on  the  skin  and  gaseous  matter  from  the  stomach 
and  mouth.  If  the  teeth  are  not  in  good  condition, 
or  if  diseases  of  the  digestive  canal  or  the  respira- 
tory tract  exist,  substances  with  a  very  foul  odor 
may  be  eliminated  with  the  breath.  Other  not 
uncommon  sources  of  unpleasant  odors  that  may 
be  present,  even  when  there  is  good  ventilation, 
are:  Dirty  garbage  pails;  improperly  flushed 
toilets,  or  hoppers;  defective  sewers,  gaspipes  or 
stoves;  and,  in  a  sick-room,  an  odor  that  is  very 
difficult  to  get  rid  of  will  arise  if:  (i)  The  bedpan 
is  not  properly  covered  immediately  after  it  has 
been  used  and  thoroughly  cleansed  as  soon  as  it  is 
emptied;  (2)  the  bedclothes2  are  allowed  to  remain 
over  the  patient  while  she  is  having  a  defecation ; 
(3)  the  patient  is  not  properly  cleansed  after  a 
defecation,  or  (4)  she  is  not  bathed  sufficiently 
often;  (5)  the  bedclothes  are  not  changed  when 
soiled. 

As  previously  stated,  gases  from  defective  sewers, 
gaspipes,  and  furnaces  may  be  injurious,  but  ex- 
periments have  shown  that  the  substances  usually 
responsible  for  odor  in  badly  ventilated  rooms  are 
not  harmful.  Nevertheless,  if  there  is  an  un- 

1  Fatty  matter  secreted  by  the  sebaceous  glands  in  the  skin. 
It  helps  to  keep  the  skin  soft  and  pliable.  When  present  in  excess 
it  gives  the  skin  a  greasy  appearance  and  that  from  the  sebaceous 
glands  in  the  scalp  makes  the  hair  oily. 

8  They  should  be  folded  down  to  the  foot  of  the  bed  as  de- 
scribed later  and  a  sheet  and,  if  necessary,  a  blanket  kept  for  the 
purpose  substituted. 


20  Nursing  Methods 

pleasant  odor  in  a  room,  the  ventilation  of  the 
latter  is  to  be  rectified  for,  even  if  the  cause  of  the 
odor  is  harmless,  its  presence  indicates  that  less 
easily  detected,  but  possibly  harmful,  conditions 
probably  exist. 

An  important  point  to  remember  in  this  respect 
is  that  the  olfactory  nerves  (those  connected  with 
the  sense  of  smell)  very  quickly  become  accus- 
tomed to  a  stimulus  and  then  cease  to  be  affected 
by  it,  so  that,  after  being  in  a  room  for  a  few 
minutes,  one  may  cease  to  perceive  an  odor,  even 
when  it  seemed  particularly  strong  and  obnoxious 
at  first.  For  this  reason,  those  responsible  for  the 
ventilation  of  a  sick-room  should  accustom  them- 
elves  to  detecting  an  odor,  if  present,  on  first 
entering  the  room. 

From  what  has  been  said,  it  will  be  realized  that 
to  obtain  good  ventilation:  (i)  The  incoming  air 
must  be  pure.  (2)  The  air  in  the  room  must  be 
kept  as  active  as  possible  without  creating  a  draft.1 
(3)  If  it  is  so  cold  out  of  doors  that  the  windows  can- 
not be  opened  widely  it  is  better  to  lower  the  top 
sash,  than  to  raise  the  bottom  one,  or  else  to  have 
a  small  opening  both  at  the  top  and  at  the  bottom 
of  the  window.  (4)  If  there  are  two  windows  in 
the  room  one  should  be  opened  at  the  top  and  the 
other  at  the  bottom,  so  that  the  openings  will  not 

1  It  is  now  generally  believed  that  unless  a  draft  is  cold  enough 
to  make  a  person  feel  chilled  it  is  not  likely  to  have  a  bad  effect 
and  that  more  people  are  injured  by  remaining  where  the  air  is 
stagnant  than  by  drafts. 


Care  of  Sick-Room  and  Utensils  21 


be  directly  opposite  each  other  nor  on  the  same 
level. 

In  very  cold  weather  there  may  be  enough 
difference  between  the  temperature  of  the  incoming 
air  and  that  in  the  room  to  allow  of  an  arrangement 
such  as  is  shown  in  Figure  2,  inducing  sufficient 
movement  in  the  air  to  obtain  fairly  good  ventila- 
tion. This  illustration  shows 
a  narrow  board  placed  be- 
neath the  lower  sash;  the 
upper  edge  of  the  lower  sash 
is  thus  raised  above  the  bot- 
tom of  the  upper  one.  This 
deflects  the  cold  air,  which 
enters  between  the  two 
sashes,  upward  and  thus  it 
does  not  blow  on  the  in- 
mates of  the  room. 

Even  in  very  cold  weather 
the  sick-room  should,  as  a 
rule,  be  thoroughly  venti- 
lated, at  least  twice  daily  by 
opening  the  windows  widely. 
If  necessary,  before  doing  so, 
extra  covers  should  be  put 


Fig .  2.  Method  of  venti- 
lating a  room  by  raising  the 
lower  sash  on  a  board.  The 
arrows  indicate  the  direction 
taken  by  the  incoming  air. 


over  the  patient  and  a  screen  placed  between  the 
bed  and  window. 

The  best  temperature  at  which  to  keep  the  sick- 
room depends  upon  the  patient's  condition.  As 
a  rule,  about  66°  to  70°  F.  is  advisable  in  the  day- 
time and  between  60°  and  65°  F.  at  night.  Some- 


22  Nursing  Methods 

times,  however,  especially  if  the  patient  has  a  high 
temperature,  the  doctor  may  require  the  room  to 
be  kept  at  a  lower  temperature. 

Necessity  for  Cleanliness  in  the  Sick-Room  and 
Causes  of  the  Transmission  of  Disease 

After  it  was  discovered  that  a  large  number  of 
diseases  were  caused  by  the  minute  organisms 
known  as  bacteria,  which  are  almost  omnipresent, 
it  was  thought  that  the  air  and  dust  fairly  teemed 
with  disease  producing  germs,  but  it  has  been 
found  that  the  organisms  which  cause  disease  are 
not  nearly  as  prevalent  as  was  supposed,  because 
most  of  these  species  are  readily  killed  by  sunlight 
and  by  drying  and  they  depend  upon  material 
that  they  find  in  the  animal  body  for  subsistence. 
Nevertheless,  though  dust  may  not  in  itself  be 
quite  the  source  of  danger  that,  until  recently,  it 
was  supposed  to  be,  its  presence  is  likely  to  protect 
and  hide  what  is  a  source  of  danger.  For  example, 
the  germs  that  cause  many  of  the  infectious  diseases, 
such  as  tuberculosis,  measles,  scarlet  fever,  menin- 
gitis, infantile  paralysis,  diphtheria,  influenza, 
some  types  of  pneumonia  and  colds,  are  in  the 
secretions  of  the  nose  and  mouth  of  a  patient  who 
has  any  one  of  these  diseases.  Therefore,  the  drops 
that  are  ejected  when  the  patient  coughs  may 
contain  millions  of  the  bacteria.  As  patients 
suffering  with  these  diseases  often  have  consider- 
able trouble  breathing,  and  are  not  always  con- 


Care  of  Sick- Room  and  Utensils  23 

scious  of  what  they  are  doing,  they  are  likely  to 
cough  frequently  and  with  force  and  drops  of 
sputum  may  go  a  considerable  distance.  Now,  if 
the  room  is  dirty  and  dusty,  the  lodging  plane  of 
the  virus  may  not  be  perceived  and,  the  dirt  may 
protect  the  substance  from  air  currents  and  light 
and  thus  retard  its  drying  and  the  destruction  of 
the  germs,  and,  if  the  infected  place  is  not  well 
cleansed  it  affords  a  source  of  infection  for  anyone 
who  touches  it  and  later  puts  her  hand  to  her 
mouth  or  touches  food  or  some  other  object  that 
is  put  in  the  mouth  or  that  comes  in  contact  with 
food. 

The  germs  causing  typhoid  and  certain  types  of 
diarrhea  and  some  other  less  common  diseases  are 
present  in  the  f  eces  and  sometimes  in  the  urine  and 
anything  becoming  soiled  with  these  excreta  will 
be  a  source  of  infection.  With  care,  however,  it  is 
easier  to  limit  the  danger  of  infection  by  these  or- 
ganisms than  by  those  that  are  contained  in  the 
mouth  and  nose  secretions.  Care  implies  the 
immediate  disinfection  of  anything  that  becomes 
soiled  with  the  excreta. 

Flies,  it  is  believed,  form  one  of  the  most  com- 
mon vehicles  for  the  transmission  of  infection  when 
excreta  of  any  kind  is  not  properly  removed  and 
disinfected,  because,  when  they  alight  on  such 
material,  their  feet  and  wings  become  soiled  with 
the  virus  and  they  carry  this  to  whatever  they 
alight  on  next,  and  this  may  be  food  or  something 
that  will  come  in  contact  with  food.  Therefore  the 


24  Nursing  Methods 

fly  that  is  allowed  to  enter  and  escape  from  the 
environment  of  a  person  suffering  with  an  infec- 
tious disease  is  a  menace.  It  is  said  that  if  flies 
could  be  exterminated  one  of  the  greatest  causes 
of  the  spread  of  disease  would  be  eliminated. 

Mosquitoes  also  are  a  menace,  especially  in 
localities  where  malaria  and  yellow  fever  are  pre- 
valent, because  certain  species,  a  different  one  for 
each  of  these  diseases,  will  absorb  the  organisms 
causing  the  disease  when  they  bite  a  person  who 
has  been  already  infected  and  they  afterward  inject 
them  into  the  blood  of  another  victim. 

Thus  it  can  be  seen  that  the  room  occupied  by  a 
sick  person  must  be  kept  particularly  clean  and  it 
should  be  screened,  so  that  flies  and  mosquitoes 
will  not  be  able  to  enter  and,  if  they  do,  they  should 
be  killed. 

There  is  another  cause  for  the  spread  of  com- 
municable diseases,  knowledge  of  which  is  so 
important  that  a  few  words  regarding  it  will  be 
inserted  here,  though  it  is  not  especially  connected 
with  the  care  of  the  sick-room.  It  is  that  bacteria 
may  live  as  parasites1  within  the  body  of  an  indi- 
vidual without,  at  least  at  once,  making  the  host2 
actively  ill,  but,  though  not  ill,  or  only  very  slightly 
so,  the  individual  may  infect  towels,  drinking  cups, 
or  other  utensils  that  she  uses  and,  if  the  bacteria 

1  Bacteria  that  cause  disease  are  called  parasites  because  they 
derive  their  sustenance  from  the  tissues  of  the  individual  whose 
body  they  invade. 

2  Any  animal  or  plant  within  or  upon  which  another  organism 
lives  parasitically,  is  termed  a  host. 


Care  of  Sick-Room  and  Utensils  25 

are  harbored  in  the  mouth  or  nose,  eject  the  germs 
if  she  coughs  or  sneezes.  The  reasons  for  this  are : 
(i)  It  takes  some  time  after  a  person  becomes 
infected  with  bacteria  for  the  latter  to  multiply  and 
induce  a  sufficient  amount  of  toxin1  to  poison  the 
individual  and  thereby  produce  the  conditions  and 
symptoms  of  disease.  This  interval  between  the 
time  that  the  person  becomes  infected  and  the 
appearance  of  the  acute  symptoms  of  the  disease 
is  known  as  the  period  of  incubation.  (2)  A  person 
may  have  such  a  slight  attack  of  a  disease  that  the 
symptoms  are  not  recognized  and  yet  the  bacteria 
given  off  from  the  body  may,  if  they  invade  a 
person  more  susceptible  to  their  influence,  cause  a 
virulent  and  possibly  fatal  infection.  (3)  Some- 
times a  person,  after  recovering  from  an  infectious 
disease,  even  an  unrecognized  attack,  becomes 
what  is  known  as  a  carrier,  that  is,  she  continues  to 
harbor  the  germs  in  her  body  but,  because  she  is 
immune,  their  poisons  no  longer  affect  her. 

To  understand  what  is  meant  by  immune  and 
why  some  people  are  more  susceptible  to  infection 
than  others,  it  must  be  known  that  the  body  is 
provided  with  several  means  of  protecting  itself 
against  bacteria,  some  of  these  are  classed  as  anti- 

1  Bacteria,  like  all  other  living  organisms,  require  food  to  main- 
tain their  life  and  those  which  cause  disease  in  man  get  their  food 
from  material  in  the  human  body.  In  the  assimilation  of  their 
food  chemical  substances  are  formed  which  are  poisonous  to 
human  beings  and  are  therefore  termed  toxins.  The  toxins  pro- 
duced by  different  species  of  bacteria  are  dissimilar  and  therefore 
they  produce  different  symptoms. 


26  Nursing  Methods 

bacterial  substances,  because  they  destroy  or  lessen 
the  vitality  of  bacteria,  and  others  are  known  as 
antitoxins,  because  they  unite  with  substances  usual- 
ly spoken  of  as  toxins  formed  by  bacteria  and  there- 
by prevent  them  injuring  the  body  cells.  Some  of 
these  substances  are  natural  constituents  of  the 
blood,  others  are  only  evolved  as  the  result  of  an 
attack  of  a  disease  or  by  vaccination.  The.  pro- 
tective substances  formed  in  the  body  as  the  result 
of  bacterial  invasion  are  more  or  less  specific,  that 
is,  they  can  only  be  depended  upon  to  protect  the 
individual  from  the  same  species  of  bacteria,  or 
their  toxins,  as  those  which  caused  their  formation, 
though,  it  is  now  thought,  they  may  possibly  have 
some  slight  restraining  effect  upon  some  others. 
For  example,  if  a  person  has  had  typhoid  fever, 
she  is  not  likely  to  have  a  second  attack  but  the 
substances  in  her  body  which  serve  to  prevent  the 
second  attack  cannot  be  relied  upon  to  protect 
her  from  any  other  disease,  though,  it  is  just 
possible,  they  may  do  so  to  a  slight  extent,  es- 
pecially diseases  caused  by  bacteria  that  resemble 
the  typhoid  bacillus,  which  is  the  cause  of  typhoid 
fever. 

The  amount  of  natural,  as  well  as  acquired,  pro- 
tective substances  in  the  blood  varies  in  different 
individuals  and  even  in  the  same  individual  at 
different  times,  and  the  former  are  likely  to  be 
diminished  when  a  person  is  in  ill  health.  Natur- 
ally, a  person  who  has  a  relatively  large  amount  of 
protective  substances  in  her  system  is  not  as  likely 


Care  of  Sick-Room  and  Utensils  27 

to  contract  infectious  diseases  as  an  individual  who 
has  a  smaller  supply. 

Important  Points  to  be  Considered  and  the 
Methods  Used  in  Cleaning  Sick-Rooms 

I.  It  is  to  be  remembered  that  scattering  the 
dust  from  one  place  to  another  will  not  make  a 
room  clean.  Therefore,  when  sweeping,  keep  the 
broom  close  to  the  floor.  Sweeping  the  floor, 
however,  is  not  the  best  way  of  cleaning  it.  Prefer- 
able methods  are  to  take  up  the  dust  with  a  vac- 
uum cleaner,  or,  if  this  cannot  be  obtained,  and 
the  floor  is  carpeted,  to  sweep  the  dust  out  from 
around  the  walls  and  the  corners  and  then  take  it 
up  with  a  carpet  sweeper  or,  if  a  polished  floor  and 
rug  are  the  problem,  to  use  an  o' cedar  or  similar 
mop  on  the  floor  and  the  carpet  sweeper  on  the  rug. 
If  the  baseboard  is  painted  white  the  mop  should 
be  covered  with  a  duster  while  dusting  the  floor 
near  the  wall  because  the  oil  on  the  mop  is  likely  to 
discolor  the  white  paint.  As  previously  stated,  it 
is  well,  when  possible,  to  have  a  rug  that  is  small 
enough  to  be  removed  without  disturbing  the  bed 
or  other  heavy  furniture  and  in  such  case,  when 
there  is  no  vacuum  cleaner  (if  the  patient  has  not 
an  infectious  disease)  the  rug  should  be  taken  from 
the  room  occasionally  and  vigorously  brushed  or 
beaten. 

To  avoid  scattering  dust  while  dusting,  be  care- 
ful not  to  flick  the  duster  around  and  it  is  well  to 


28  Nursing-  Methods 

use  a  moist  duster  on  articles  that  will  not  be  injured 
by  the  moisture.  Those  which  are  likely  to  be  are : 
Lacquered  metals  and  surfaces,  as  walls,  that  are 
colored  with  water  paints  or  kalsomme ;  and  water 
will  dull  varnished  or  waxed  surfaces,  but  for  these 
the  duster  can  be  slightly  moistened  with  the 
various  preparations,  such  as  o'cedar  oil,  that  are 
intended  for  the  purpose.  Only  the  minutest 
amount  of  oil  is  required  and  more  should  not  be 
used  for,  if  the  wood  is  left  greasy,  dust  will  stick 
to  it  and  may  be  hard  to  remove. 

2.  Do  not  use  a  dirty  duster  or  dirty  water  for 
dusting  and  cleaning. 

3.  Dust  higher  shelves,  etc.,  before  lower  ones. 

4.  When    dusting,    for    example,    a    bed   do 
not  forget  the  bar  and  shelves  that  are  out  of 
sight. 

5.  Form  the  habit  of  removing  dust  with  one 
firm  stroke,  it  is  waste  of  time  and  energy  to  move 
the  duster  back  and  forth  over  a  surface  unnecessa- 
rily, as  is  very  commonly  done. 

6.  Do  not  use  alkaline  soaps  and  cleansing 
powders1  on  painted  surfaces  and  enamel  bath- 
tubs, sinks,  etc.    Bon  ami  is  good  for  these  pur- 
poses, except  for  colored  walls,  which  it  is  very 
likely  to  streak,  because  the  powder  is  not  easily 
removed  from  between  the  granules  of  plaster; 

1  Most  of  the  laundry  soaps  and  the  cleansing  powders  used  for 
cleaning  tiles,  cement,  and  unvarnished  wood  contain  some  free 
alkali.  This  increases  their  detergent  powers  and  makes  them 
valuable  for  these  purposes,  but  alkali  tends  to  dull  and  roughen 
enamel  ware  and  glass. 


Care  of  Sick -Room  and  Utensils  29 

neutral  soaps,,  as  ivory,  and  warm  water  are  the 
best  detergents  for  this  purpose. 

Care  of  Cleaning  Utensils 

Wash  dusters  after  use  and,  when  possible,  hang 
them  in  the  sunlight  to  dry.  Wash  brooms  and 
brushes  in  soap  and  water  when  they  look  dirty 
and  remove  dust  from  brushes  with  a  metal  comb, 
which  should  be  kept  for  the  purpose.  If  there  is 
no  suitable  place  in  which  to  shake  the  dust  off  a 
dusting  mop,  or  when  it  has  been  used  in  the  room 
of  a  patient  suffering  with  an  infectious  disease, 
put  a  rubber  glove  or  an  old  kid  one  on  your  hand 
and  pick  the  dust  off  the  mop,  then  put  the  soft 
part  of  the  mop  in  a  paper  or  thick  muslin  bag,  tie 
this  tightly  around  the  handle  and  shake  the  mop. 
When  the  mop  is  dirty,  soak  it  in  kerosene  or  boil 
it  in  water  and  soda  (about  one  teaspoon  of  soda 
to  a  quart  of  water).  After  it  is  dry  sprinkle  a 
small  amount  of  o'cedar  or  other  polishing  oil 
over  it. 

Care  of  Sick-Room  Utensils 

After  emptying  a  bedpan  or  sputum  cup1  rinse 
it  with  cold  water  until  every  particle  of  the  ex- 

1  When  possible  paper  sputum  cups,  which  are  not  emptied,  but 
burned,  should  be  used.  A  patient  with  any  of  the  diseases  men- 
tioned on  page  22  should  use  paper  napkins  for  handkerchiefs 
and  these,  when  soiled'  should  be  put  in  a  paper  bag  which,  with 
its  contents,  should  be  burned. 


30  Nursing  Methods 

creta  has  been  removed  and  then  scald  it  with  hot 
water.  If  it  is  not  easily  cleaned  use  a  small  sink 
brush  to  rub  off  adherent  matter.  After  using  the 
brush  for  this  purpose,  do  not  use  it  for  any 
other,  but  keep  it  for  similar  use  in  a  disinfectant 
until  all  likelihood  of  its  being  again  required  has 
passed. 

Rubber  articles,  as  hot-water  bags,  ice-caps,  and 
rubber  tubing  and  syringes  are  easily  ruined  if  they 
are  not  cared  for  properly,  because  rubber  is  rotted 
if  it  is  exposed  to  a  high  temperature  (as  that  of 
boiling  water)  for  a  long  time;  if  it  is  put  away 
moist,  and  if  it  is  left  in  contact  with  oils,  acids,  and 
alkalies.  Therefore,  clean  such  articles  carefully 
before  putting  them  away  and  do  not  use  alkalies, 
as  ammonia  and  soda,  or  strong  laundry  soaps 
(which  contain  free  alkalies)  for  cleaning  them; 
use  a  neutral  soap,  as  ivory.  If  they  require  to  be 
disinfected,  boil  them,  but  not  longer  than  five 
minutes  and  when  filling  a  hot-water  bag  for  use, 
do  not  use  water  that  has  a  higher  temperature 
than  1 80°  or  190°  F.  Be  sure  that  rubber  articles 
are  dry  before  putting  them  away ;  to  dry  the  in- 
terior of  a  hot-water  bag  or  rubber  tubing  hang  the 
article  where  it  will  drain  and  stretch  tubing  occa- 
sionally; dry  the  interior  of  an  ice-cap  with  a  towel 
or  soft  muslin  and  let  it  stand  for  some  time  with 
the  cover  off.  When  putting  on  the  cover  of  an 
ice-cap  or  inserting  the  stopper  of  a  hot-water  bag, 
leave  enough  air  in  the  articles  to  keep  their  sides 
from  sticking  to  each  other  and  put  them  away  in 


Care  of  Sick- Room  and  Utensils  31 

boxes,  for  the  rubber  is  easily  punctured  and  even 
a  pinhole  will  render  them  useless. 

The  bed  linen,  table  covers,  and  the  like  used  in 
the  sick-room  are  so  frequently  stained  that  it  is 
well  to  remember  how  to  remove  the  stains  that 
most  commonly  occur. 

A  rule  that  holds  good  for  all  stains  is,  if  possible 
to  avoid  it,  do  not  let  a  stain  dry;  if  means  to  erase 
it  cannot  be  taken  at  once,  place  the  stained  article 
in  warm  water  and  later  use  the  special  reagent  for 
removing  it. 

To  remove  stains  made  with  coffee  and  tea, 
soak  and  then  wash  the  stained  part  in  boiling 
water  and  soapsuds. 

To  remove  ink  stains  soak  the  stain  in  warm 
water  then  cover  it  with  lemon  juice  and  salt  and 
place  it  in  the  sunlight;  when  dried,  wash  it  in 
warm  water,  if  the  stain  has  not  been  removed, 
repeat  the  procedure. 

Stains  made  with  most  medicines  can  generally 
be  removed  by  soaking  the  stain  for  some  time  in 
alcohol  and  then  washing  it  with  soap  and  hot  water. 

Iodine  stains  are  most  easily  removed  by  soak- 
ing them  in  ammonia  water  and  then  washing  the 
material  in  soap  and  water.  Sometimes  soap  and 
water  or  alcohol  alone  will  remove  the  stain,  if  it  is 
treated  as  soon  as  it  is  made  and  the  iodine  is  not 
allowed  to  dry. 

Silver  nitrate  stains  can  be  removed  by  covering 
the  stain  with  iodine  and  then  removing  the  latter 
as  just  described. 


32  Nursing  Methods 

The  Disinfection  of  Sick-Room  Utensils 

By  disinfection  is  meant  the  destruction  of  bac- 
teria. As  stated  in  the  first  part  of  this  section, 
anything  that  becomes  soiled  with  material  con- 
taining bacteria  must  be  disinfected. 

The  surest  way  of  destroying  bacteria  is  to  boil 
the  contaminated  article.  If  this  consists  of  metal 
or  of  porcelain  or  other  hard  substance  that  bac- 
teria cannot  penetrate,  five  minutes  boiling  will  be 
sufficient,  but  more  time  must  be  allowed  if  the 
bacteria  are  not  likely  to  be  at  once  exposed  to  the 
heat,  as,  for  example,  if  bundles  of  sheets  are  boiled 
in  a  receptacle  that  is  so  small  that  the  sheets  are 
pressed  together,  or  if  the  sheets  are  soiled  with 
feces  or  sputum  which  are  hardened  by  heat  and 
may  therefore  protect  the  bacteria  for  a  short  time. 
When  heat  is  used  to  destroy  bacteria,  the  process 
is  usually  spoken  of  as  sterilization. 

For  many  reasons,  it  is  sometimes  impossible 
to  make  use  of  heat  to  destroy  bacteria,  and  then 
chemicals,  known  as  disinfectants  or  germicides,  are 
employed.  There  are  a  number  of  good  disinfec- 
tants to  be  had,  there  are  also  a  number,  widely 
advertised,  that  are  practically  useless,  and  many  of 
those  that  are  efficient  germicides  will  stain  linen, 
or  corrode  metal,  or  have  other  undesirable  quali- 
ties which  limit  their  usefulness. 

Naturally,  for  home  use,  disinfectants  that  can 
be  employed  for  the  largest  number  of  purposes  are 
to  be  preferred.  Lysol  and  iodine  are  good  ones  to 


Care  of  Sick- Room  and  Utensils  33 

have  in  the  emergency  chest  (this  will  be  referred 
to  again  in  the  chapter  describing  the  care  of 
wounds)  and  lysol  and  chloride  of  lime  are  two  of 
the  best  ones  to  have  when  caring  for  a  person  with 
an  infectious  disease. 

Lysol  is  a  mixture  of  soap  and  of  the  chemicals 
known  as  cresols  which  are  similar  to  carbolic  acid, 
but  they  are  stronger  germicides.  Because  of  its 
soap,  lysol  cleans,  as  well  as  disinfects,  and  thus  it 
is  particularly  good  for  the  disinfection  of  the  skin 
and  of  instruments  and  utensils.  It  can  also  be 
used  for  the  disinfection  of  linen,  excreta,  and 
toilets,  but  for  the  two  purposes  last  mentioned 
cheaper  disinfectants,  such  as  chloride  of  lime,  will 
answer  equally  well. 

For  the  disinfection  of  the  skin,  utensils,  and 
linen,  a  I  per  cent,  solution  of  lysol  is  generally 
used,  that  is,  2^/2  teaspoonfuls  (approximately  10 
c.c.)  of  the  concentrated  lysol  is  used  to  make  I 
quart  (approximately  1000  c.  c.);  warm  water  is 
used  as  the  diluent.  For  the  disinfection  of  uten- 
sils, the  solution  is  generally  prepared  once  a  day 
in  a  pail  and,  after  a  used  utensil  has  been  cleaned, 
it  is  put  into  the  solution  and  left  for  about  an  hour 
or  until  it  is  needed  again,  when  it  is  dried  with  a 
towel  kept  for  the  purpose.  A  solution  for  dis- 
infecting the  hands  is  usually  prepared  in  a  toilet 
basin  and  kept  where  it  can  be  conveniently 
reached,  for  the  hands  should  be  well  rubbed  with 
it  after  doing  anything  for  the  patient.  Unless 
it  becomes  soiled,  the  same  solution  can  be  used 


34  Nursing  Methods 

repeatedly,  but  a  fresh  supply  should  be  prepared 
at  least  once,  and  usually  twice,  daily.  For  the 
disinfection  of  feces  and  sputum,  enough  of  the 
concentrated  lysol  is  used  to  make  the  mass  about 
4  per  cent.,  that  is,  if  there  seems  to  be  about  one 
cup  full  of  excreta  (approximately  250  c.  c.)  about 
2^/2  teaspoonfuls  (10  c.c.)  of  lysol  is  used.  Enough 
lysol  to  make  urine  I  per  cent,  is  generally  sufficient, 
as  it  comes  more  readily  in  contact  with  the  bac- 
teria. After  the  addition  of  the  lysol,  the  excreta 
should  be  allowed  to  stand  for  fifteen  to  twenty 
minutes  before  being  emptied.  Lysol,  however,  is 
not  as  good  a  disinfectant  for  excreta  as  chloride 
of  lime. 

Chloride  of  lime  (bleaching  powder),  in  the  same 
percentages  as  lysol,  is  about  the  best  disinfectant 
for  excreta,  toilets,  and  privy  vaults.  It  can  also 
be  used  in  a  I  per  cent,  solution  for  the  disinfection 
of  linen,  but  the  latter  must  be  well  washed  in 
several  waters  after  removal  from  the  disinfectant 
or  it  may  be  destroyed. 

Unslaked  lime  is  a  cheap  and  efficient  disin- 
fectant for  excreta  that  is  to  be  emptied  into  a 
privy  vault  and  for  the  vault,  but  it  has  to  be  used 
with  caution  for,  if  it  comes  in  contact  with  the 
flesh,  it  is  likely  to  cause  severe  burns  and  it  will 
destroy  linen  and  corrode  metal.  The  chemical 
reaction  that  occurs  when  the  lime  is  added  to 
excreta  is  attended  with  the  evolution  of  such 
intense  heat  that  disinfection  occurs  very  quickly. 

Chlorine  and  lime  disinfectants  must  be  kept 


Care  of  Sick- Room  and  Utensils  35 

tightly  covered,  or  their  efficiency  will  be  reduced. 
Some  important  rules  to  remember  in  connec- 
tion with  disinfection: 

1.  Only    use    disinfectants    that    are    recom- 
mended by  competent  authorities. 

2.  Always  use  the  full  amount  of  disinfectant 
that  you  are  told  to  and  let  the  article  remain  in  the 
disinfectant  the  time  advised. 

3.  Be  sure  that  the  disinfectant  can  penetrate 
contaminated  material,  if  this  is  of  a  nature  to  be 
penetrated  by  bacteria,  for  disinfectants  have  to 
come  in  actual  contact  with  bacteria  in  order  to 
destroy  them.    For  example,  if  a  typhoid  patient 
passes  hard  masses  of  feces  and  the  disinfectant  is 
merely  poured  over  the  mass,  millions  of  bacteria 
may  remain  alive  and  active  in  the  interior.    There- 
fore, hard  masses  of  feces  should  be  broken.     The 
disinfection  of  excreta  emptied  into  privy  vaults  is 
particularly  important,  because,  when  in  the  ex- 
crement, the  bacteria  have  the  material  they  need 
for  their  sustenance  and  will  multiply  enormously, 
and  the  ground  water  percolating  through  the  soil 
may  wash  bacteria  into  the  wells,  streams,  etc.,  in 
the  neighborhood.    Several  epidemics  of  typhoid 
have  been  traced  to  this  source. 

4.  Disinfectants  are  poisonous  to  human  be- 
ings, some  of  them  extremely  so  and,  therefore, 
bottles  containing  them  should  always  be  clearly 
labeled  and  kept  in  a  locked  receptacle. 

5.  Proper  disinfection  of  the  hands  is  extremely 
important  and,  as  they  cannot  be  kept  in  the  dis- 


36  Nursing  Methods 

infectant  long  enough  to  insure  the  destruction  of 
the  bacteria,  they  must  be  well  rubbed  and 
scrubbed.  Also,  to  prevent  the  contamination  of 
the  hands  as  much  as  possible,  rubber  gloves  should 
be  worn  when  cleaning  infected  utensils  and  the 
like.  Cold  cream  or  other  lubricant  should  be  used 
freely  to  prevent  the  hands  being  roughened  by 
the  disinfectant  and  frequent  scrubbing,  and  the 
nails  should  be  kept  short — long  nails  and  rough- 
ened skin  hinder  disinfection. 

6.  Whenever  possible  infected  bed  linen  and 
the  like  should  be  boiled,  rather  than  disinfected. 
The  linen  can  be  put  into  a  pail  when  it  is  removed 
from  the  bed  and  covered  with  water,  and  the  boil- 
ing done  when  convenient. 


CHAPTER  II 

Methods   of   Moving,   Lifting,  and  Carrying 
Patients ' 

Important  points  to  remember  when  moving,  lifting,  and  carry- 
ing people.  Demonstration  2:  How  to:  Raise  a  patient's  head; 
turn  a  patient  on  her  side;  draw  her  to  the  side  of  the  bed;  move 
her  up  in  bed;  raise  her  to  a  sitting  position;  lift  her  from  the  bed; 
carry  her. 

Equipment  for  demonstration : 

A  bed  with  the  ordinary  bedding,  the  upper 
covers  folded  back  to  the  foot  of  the  bed. 

A  subject:  It  will  probably  be  advisable  to 
have  a  small  child  act  as  subject  for  the  last  proce- 
dure— carrying  the  patient — but  the  pupils  should 

*  To  the  Teacher:  The  procedures  of  this  lesson  have  been 
arranged  separately,  instead  of,  according  to  the  usual  custom,  in 
connection  with  bed-making  in  order  (i)  that  the  pupils  may 
appreciate  that  they  are  to  be  carried  out  whenever  a  helpless 
person  is  moved,  and  not  only  when  making  the  bed ;  (2)  to  afford 
a  means  of  drill  and  of  focusing  the  pupils'  attention  upon  what 
are  often  the  most  important  and  difficult  procedures  in  the  care 
of  a  sick  person  and,  though  few  of  the  pupils  of  a  high  school  are 
likely  to  be  called  upon  to  care  for  a  helpless  patient,  if  they  study 
nursing  procedures  at  all  they  should  learn  to  do  work  of  this  kind 
well,  if  only  because  such  ability  will  do  much  to  remove  the  fear 
of  doing  anything  for  a  sick  person  which  so  many  people  have,  and 
which  makes  it  so  difficult  for  a  nurse  to  get  members  of  a  patient's 
family  to  help  her  when  she  needs  assistance. 

37 


38  Nursing  Methods 

take  turns  being  "the  patient "  for  the  other  proce- 
dures of  this  lesson,  because  experiencing  the  sen- 
sations produced  helps  them  to  appreciate  how  the 
movements  should  be  made. 
Points  to  be  considered  in  moving  a  patient: 

1.  When  a  patient  is  very  ill,  especially  when 
her  heart  action  is  rapid  or  weak,  moving  must  be 
done  without  her  assistance. 

2 .  It  is  often  important  that  a  patient  be  moved 
as  little  as  possible. 

3.  Do  not  attempt  to  move  a  patient  until  you 
are  sure  that  there  is  nothing  (e.g.,  bedcovers)  to 
hamper  her  movements. 

4.  When  two  or  more  persons  are  moving  a 
patient,  they  must  work  in  unison,  and  in  order 
to  do  so  one  must  take  the  lead  and  give  necessary 
directions  and  the  word  to  move  when  all  is  ready. 

5.  When  necessary  to  lean  forward  while  mov- 
ing or  lifting  a  patient,  bend  from  your  hips  and 
keep  your  shoulders  thrown  back. 

6.  When  necessary  to  lift  a  patient's  thighs,  as 
when  passing  a  sheet  under  her,  except  when  she  is 
very  weak  or  has  some  injury  of  the  legs,  flex  her 
knees,  and  have  the  soles  of  her  feet  flat  upon  the 
bed.    When  in  this  position  a  patient  can  usually 
help  to  raise  herself  and,  even  if  she  is  unable  to 
do  so,  it  is  easier  to  lift  her  if  her  thighs  are  raised 
from  the  bed  as  they  are  when  her  knees  are  flexed. 

7.  When  lifting  a  patient's  shoulders,  support 
her  head.    To  do  this,  bend  your  elbow  slightly, 
pass  your  arm  behind  the  patient,  place  your  hand 


Moving  Patients 


39 


firmly  under  her  far  shoulder  and  your  fingers  in 
the  axilla,  let  her  head  rest  in  the  bend  of  your 
elbow,  see  Fig.  3.  When  passing  your  arm  behind 
the  patient  raise  her  head  with  your  free  hand. 


Fig.  3.     Method  of  supporting  head  and  shoulders  while  ad- 
justing pillows,  etc. 

Important  points  to  consider  when  lifting  and 
carrying  a  patient  are : 

1.  Before  lifting  a  patient  from  the  bed  draw 
her  to  the  edge  in  order  to  minimize  the  necessary 
degree  of  stooping. 

2.  When  stooping  is  unavoidable,   bend  the 
knees  and  hips  and  keep  the  shoulders  thrown 
back;  do  not** bend  the  back,  especially  when  you 
have  a  weight  on  your  arms. 

3.  When  lifting  or  carrying  a  patient  do  not  let 
her  put  her  arms  around  your  neck,  but  have  her 
put  them  across  your  chest  and  back  (under  your 
arm  nearest  her)  and  clasp  her  hands  on  your  far 


40  Nursing  Methods 

shoulder.  More  weight  is  thus  thrown  on  your 
shoulder,  and  less  upon  your  back;  the  shoulders 
are  not  easily  strained  by  a  weight  and  the  back  is. 

4.  Before  lifting  a  conscious  patient,  tell  her  to 
hold  herself  as  stiffly  as  possible  while  you  are 
lifting  and  carrying  her. 

5.  If  a  patient  is  to  be  carried,  before  lifting  her, 
see  that  there  is  no  obstruction  between  you  and 
your  goal. 

6.  When  two  or  more  persons  are  carrying  a 
patient  in  their  arms  they  should  step  in  unison, 
but  not  with  the  same  foot;  i.e.,  when  one  steps 
with  the  right  foot  her  neighbor  should  step  with 
the  left. 

Demonstration  2 
Moving,  Lifting,  and  Carrying  a  Patient 

To  turn  a  patient  on  her  side :  By  methods  I,  2, 
and  3  the  patient  is  turned  with  her  face  toward  the 
person  moving  her,  by  method  4  she  is  turned  with 
her  back  to  the  mover. 

Method  i.  //  the  patient  is  not  helpless  all  that 
is  usually  necessary  is  to  place  one  hand  on  her 
back  between  the  shoulders  and  the  other  behind 
her  thighs.  Pass  your  hands  behind  her  on  the 
side  farthest  from  you  and  press  upward. 

Method  2.  To  turn  a  weak  or  helpless  patient, 
slip  one  arm  under  her  far  shoulder  and  obliquely 
across  her  back,  so  that  your  hand  comes  under  the 


Moving  Patients  41 

side  nearest  you;  pass  your  other  arm  under  her 
hips,  also  from  the  far  side,  raise  her  slightly,  and, 
drawing  her  somewhat  backward,  turn  her  toward 
you.  (See  Fig.  4.)  It  may  be  necessary  to  make 


Fig.  4.     Turning  a  patient. 

some  change  in  the  position  of  her  shoulders  or 
hips.  If  so,  to  move  her  shoulders,  place  your 
arms,  one  on  either  side,  around  her  body  with 
your  hands  under  her  lower  arm,  raise  her  slightly, 
and  move  her  as  required.  Have  the  pillow  under 
her  head  while  doing  this.  The  hips  can  be  moved 
in  the  same  manner. 

Method  3.  To  turn  a  heavy  patient  loosen  the 
draw  sheet1  on  one  side  and,  reaching  over  the 
patient,  grasp  the  loosened  end  of  the  sheet  on  a 
line  with  the  patient's  shoulders  and  thighs  and, 
by  pulling  it  toward  you,  turn  the  patient. 

1  See  foot  note  page  47. 


42  Nursing  Methods 

Method  4.  Slip  one  arm  under  the  patient's 
shoulders  from  the  near  side,  getting  your  hand 
as  far  as  possible  under  her  far  side.  Pass  your 
other  arm  under  the  hips  until  your  hand  comes 
well  under  the  far  thigh.  Raise  her  somewhat  and, 
drawing  her  slightly  backward,  turn  her. 

To  move  a  helpless  patient  to  one  side  of  the 
bed:  If  alone  and  the  patient  is  small,  pass  one 
arm  under  the  upper  part  of  her  back  and  the  other 
under  her  thighs  and  draw  her  toward  you. 

//  the  patient  is  tall,  put  one  arm  back  of  her 
neck  and  far  shoulder  and  the  other  under  the  small 
of  her  back  and  move  the  upper  part  of  the  body ; 
then  slip  one  arm  under  the  small  of  the  back  and 
the  other  under  the  knees  and  move  the  lower 
portion  of  the  body.  It  may  be  necessary  to  repeat 
the  procedures  once  or  twice  in  order  to  get  the 
patient  as  far  over  as  required,  but  it  is  not  essen- 
tial to  carry  them  out  in  the  same  order;  in  fact, 
it  is  better  to  move  first  the  part  of  the  body  by 
which  you  are  standing. 

//  the  patient  is  very  ill  and  heavy,  assistance 
should  be  had.  In  such  case,  support  the  patient's 
head  and  shoulders  with  one  arm  and  slip  the  other 
arm  under  the  small  of  her  back.  Have  your  assist- 
ant stand  beside  you  and  pass  one  arm  under  the 
upper  part  of  the  patient's  thighs  and  the  other 
under  her  knees.  Draw  the  patient  toward  you. 

To  move  a  patient  up  in  bed : 

Method  z.  Flex  the  patient's  knees  so  that  her 
feet  will  rest  firmly  on  the  bed.  Pass  one  of  your 


Moving  Patients  43 

arms  behind  her  and,  supporting  her  head  in  the 
bend  of  your  elbow,  grasp  her  under  her  far  arm. 
Put  your  other  arm  under  her  thighs. 

If  the  bed  is  supplied  with  a  pulley,  have  the 
patient  grasp  this;  if  it  is  not,  have  her  place  her 
hands,  palms  downward,  firmly  on  the  bed  and,  in 
either  case,  have  her  raise  herself  slightly  while  you 
draw  her  upward. 

Method  2.  If  the  patient  is  heavy  and  cannot 
help  herself  it  will  require  two  people  to  move  her 
and,  unless  the  bed  is  a  wide  one,  it  is  better  to 
stand  on  opposite  sides. 

If  possible,  flex  the  patient's  knees,  even  though 
she  cannot  help  herself ;  grasp  her  under  the  far  arm 
as  when  lifting  her  alone  and  place  your  other  arm 
under  her  back.  Have  your  assistant  place  one  of 
her  arms  near  yours  and  the  other  under  the 
patient's  thighs  or,  if  the  latter's  knees  are  not 
flexed,  under  them. 

Method  3.  Loosen  the  draw  sheet  and  roll  this 
to  the  patient's  side.  Take  hold  of  the  roll  on  a 
line  with  her  shoulders  and  thighs ;  have  an  assist- 
ant do  likewise  on  the  other  side,  taking  hold  of 
the  roll  directly  opposite  you.  Move  the  stretcher 
thus  made,  and  with  it  the  patient,  upward. 

To  raise  a  patient  into  a  sitting  position:  Pass 
your  arm  nearest  the  head  of  the  bed  behind 
her  as  in  Fig.  3,  if  necessary  and  possible,  have  the 
patient  place  her  hands  palms  downward  on  the 
bed  and,  by  pressing  upon  them,  help  lift  herself 
as  you  raise  her  into  a  sitting  position. 


44 


Nursing  Methods 


To  carry  a  patient  on  a  chair  made  with  the 
hands:  If  the  patient  is  in  bed,  draw  her  to  the 
edge,  and  then  raise  and  turn  her  so  that  she  will 
sit  with  her  legs  over  the  side. 

Grasp  your  left  wrist  with  your  right  hand  and 
have  your  assistant  clasp  her  left  wrist  in  like 
manner. 


Fig.  5.     Carrying  a  patient. 

Both  pass  your  hands  under  the  patient's  thighs 
and  each  clasp  the  other's  right  wrist  with  her  left 
hand.  Have  the  patient  place  one  hand  on  your 
far  shoulder  and  the  other  on  your  assistant's. 
Raise  her  and  walk  to  your  destination. 

To  carry  a  patient  as  shown  in  Fig.  5 :    If  the 


Moving  Patients  45 

patient  is  in  bed,  pass  your  arm  diagonally 
across  her  back,  placing,  if  possible,  your  hand  in 
her  axilla.  Pass  your  other  arm  under  her  knees. 
Have  the  patient  clasp  her  hands  on  your 
shoulder,  putting  her  arms  across  your  back  and 
chest,  never  around  your  neck  because  this  throws 
more  weight  upon  your  back. 


CHAPTER  in 

Bed-Making 

Important  points  to  be  considered  when  stripping  and  making 
a  bed.  Demonstration  3:  Stripping  a  bed  and  making  a  closed 
bfd.  Demonstration  4:  Making  a  bed  with  the  patient  in  it, 
including  changing  the  nightgown  and  turning  the  pillows. 

Equipment  for  Demonstration  3 : 

A  bed.  Small  table.  Two  chairs.  Two  pillows 
and  their  covers.  Mattress  and  mattress  protector. 
Rubber  sheet  or  quilted  pad.  Three  sheets  and 
two  blankets. 

Demonstration  3 

Stripping  a  Bed,  Making  a  Closed  Bed.    Stripping 
and  Airing  a  Bed 

The  important  points  to  be  considered  are :   To 

save  time  and  energy  by  doing  the  work  in  an 
order  that  will  entail  going  around  the  bed  as 
seldom  as  possible. 

Not  to  soil  the  clothes  by  dragging  them  on  the 
floor. 

To  so  arrange  the  clothes  after  they  have  been 
removed  from  the  bed  that  they  will  be  all  exposed 
to  the  air. 

46 


Bed-Making  47 

Procedure:  Place  two  chairs  back  to  back  two 
feet  apart. 

Place  the  pillows  upon  the  table  or  the  seats  of 
the  chairs. 

Fold  the  spread  in  its  creases  and  hang  it  where 
it  will  not  get  crushed. 

Loosen  the  clothes  all  around  the  bed.  To  do 
this  raise  the  edges  of  the  mattress  by  passing  one 
hand  along  under  it,  and  draw  out  the  clothes  with 
the  other  hand. 

Remove  the  clothes,  one  at  a  time,  taking  hold  of 
each  article  in  the  center  (this  will  prevent  their 
ends  dragging  on  the  floor),  and  place  them  over 
the  back  of  the  chairs.  Hang  the  rubber  sheet 
over  a  bar  of  the  bed. 

Turn  the  mattress  over  from  top  to  bottom1  and 
stand  it,  arched,  on  its  upper  and  lower  ends.  The 
bed  should  air  for  at  least  twenty  minutes. 

Making  a  Closed  Bed 

Points  to  be  remembered  when  making  a  bed 
that  is  to  be  occupied  by  a  sick  person  are : 

i.  Protect  the  mattress.  A  quilted  pad,  put  on 
under  the  under  sheet,2  will  be  sufficient  protec- 

1  The  mattress  should  not  be  turned  from  side  to  side,  for,  if 
it  is,  the  same  part  will  again  bear  the  heaviest  weight  of  the 
patient  and  the  mattress  will  become  dented  sooner  than  it  will 
if  properly  cared  for. 

*  The  sheets  are  usually  spoken  of  as  the  under  sheet,  the  draw 
sheet,  and  the  upper  sheet.  The  under  sheet  being  the  one  used 
to  cover  the  mattress.  The  draw  sheet  is  thus  named  because  it  is 


48  Nursing  Methods 

tion  when  the  patient  is  convalescent,  but,  when  a 
helpless  patient  has  to  use  the  bedpan,  further 
protection  is  advisable  and  either  an  extra  quilted 
pad  or  a  rubber  sheet  should  be  put  on  over  the 
under  sheet,  before  the  draw  sheet."  Ordinarily, 
this  extra  protector  and  draw  sheet  are  not  used 
when  the  patient  is  well  enough  to  be  up,  but  they 
are  shown  in  this  demonstration  because  it  is  easier 
to  learn  how  to  adjust  them  when  there  is  nobody 
in  the  bed. 

2.  Fix  the  sheets  that  will  be  under  the  patient 
so  that  they  will  remain  without  wrinkles.     This 
requires:  (a)  That  the  sheets  be  put  on  perfectly 
straight,  otherwise,  the  material  is,  as  it  were,  on 
the  bias  and  when  this  is  the  case,  if  the  sheets 
become  at  all  loosened  they  will  wrinkle;  (b)  the 
sheets  must  be  stretched  tightly  before  they  are 
tucked  under  the  mattress;  (c)  the  sides  of  the 
sheets  must  be  tucked  under  the  mattress  to  the 
center  of  the  bed  so  that  the  patient's  weight 
will  be  over  them  and  help  to  keep  them  in 
place. 

3.  Do  not  tuck  the  upper  clothes  far  under  the 

so  arranged  that  when  the  part  the  patient  is  lying  upon  gets  un- 
comfortably warm,  it  can  be  drawn  forward  and  a  fresh  part 
provided.  In  hospitals  long  narrow  sheets  are  usually  provided 
for  the  purpose  but,  in  the  home,  an  ordinary  sheet  can  be  doubled 
lengthwise  and  adjusted  with  the  length  across  the  bed.  Another 
reason  for  the  use  of  this  sheet  is  that  it  can  be  tucked  farther 
under  the  mattress  than  the  under  sheet  and  therefore  it  does  not 
wrinkle  as  easily. 

1  See  foot  note  page  47. 


Bed-Making  49 

mattress  for,  if  you  do,  the  under  ones  will  be 
loosened  when  the  bedcovers  are  turned  down. 

4.  Avoid  wasting  time  and  energy.     In  order 
to  do  so  collect  everything  that  you  will  need  for 
your  work  before  you  begin  and  do  your  work  in  an 
order  that  will  necessitate  going  round  the  bed  as 
seldom  as  possible. 

5.  Keep  the  surroundings  neat  while  you  work, 
and  do  not  consider  that  you  have  finished  making 
the  bed  until  you  have  put  the  chairs  and  table  in 
place  and  removed  everything  that  should  not  be 
left  on  the  table. 

Procedure :  Put  the  mattress  in  place  and  cover 
it  with  the  protector. 

Cover  this  with  a  sheet.  Let  the  sheet  extend 
about  eighteen  inches  beyond  the  mattress  at  the 
top  to  allow  for  tucking  in  and  leave  exactly  the 
same  length  on  either  side.  Be  sure  that  the  sheet 
is  straight.  There  are  two  methods  of  arranging 
this  sheet,  in  one  method  the  envelope  corners, 
which  help  to  hold  the  sheet  in  place,  are  made  at 
the  sides  and,  in  the  other,  the  corners  are  made  at 
the  top  and  bottom.  For  method  I,  i.e.,  with  the 
corners  at  the  sides:  Tuck  the  sheet  under  the 
mattress  at  the  top,  go  to  the  foot  of  the  bed,  pull 
the  sheet  firmly  and  tuck  it  in  there.  Miter  (i.e., 
fold  like  an  envelope)  the  upper  and  lower  corners 
(see  Fig.  6)  and  then  tuck  in  the  sheet  along  the 
side  on  which  you  are  standing.  For  method  2: 
Tuck  in  the  sheet  along  the  side  on  which  you  are 
standing,  but  leave  it  loose  at  the  top  and  bottom. 


50  Nursing  Methods 

Put  on  the  extra  protector,  placing  it  where  the 
lowef  part  of  the  back,  buttocks,  and  upper  part  of 
the  thighs  will  rest. 

Cover  this  with  the  draw  sheet.  Leave  the 
latter  a  little  bit  longer  on  the  side  at  which  you 
are  standing  than  the  other.  Tuck  it  in  on  this  side . 
It  should  extend  from  slightly  under  the  pillow  to 
about  the  same  level  of  the  patient's  knees  and  at 
least  two  inches  beyond  the  top  and  bottom  of  the 
protector. 

Go  to  the  opposite  side  of  the  bed.  Turn  back 
the  draw  sheet  and  extra  protector,  so  that  they 
will  be  out  of  your  way  while  you  first  stretch,  and 
then  tuck  the  under  sheet  beneath  the  mattress. 
To  do  this  for  method  I  miter  the  corners  on  the 
side  at  the  top  and  bottom,  as  on  the  other  side, 
stretch  a  portion  of  the  sheet  as  forcibly  as  you  can 
(Fig.  7,  in  which  the  sheet  is  being  pulled  with  one 
hand  while  the  edge  of  the  mattress  is  pushed  back 
with  the  other,  shows  a  good  way  of  getting  the 
sheet  tight)  and  then  tuck  it  as  far  under  the 
mattress  as  possible.  For  method  2 ,  treat  the  sheet 
in  the  same  manner,  but  begin  to  work  about  the 
middle  and  proceed  first  toward  the  foot  and  then 
toward  the  head  of  the  bed.  Fold  the  top  of 
the  sheet  like  an  envelope  and  tuck  it  under  the 
head  of  the  mattress  and  then  do  likewise  at  the 
foot. 

See  that  the  protector  is  in  place  and  free  from 
wrinkles,  if  it  is  so  wide  that  it  has  to  be  tucked  in 
treat  it  in  the  same  manner  as  the  draw  sheet. 


Bed-Making  51 

Stretch  and  tuck  the  draw  sheet  tinder  the 
mattress  in  the  same  way  as  the  under  sheet. 

Put  on  the  top  sheet  with  the  hem  wrong  side 
up,  so  that  the  right  side  will  be  uppermost  when 
the  sheet  is  turned  down  over  the  blanket  and 
spread.  Have  the  upper  edge  of  the  sheet  on  a  line 
with  the  rim  of  the  mattress.  Tuck  the  sheet 
under  the  mattress  at  the  foot,  miter  the  lower 
corners,  as  in  the  under  sheet,  the  sides  may  be 
allowed  to  hang  or  they  may  be  tucked  under  the 
mattress,  but  not  as  far  as  the  under  sheets.  Neat- 
ness is  the  main  consideration  in  the  arrangement 
of  the  upper  bedclothes. 

Put  on  the  blankets,  have  their  upper  edges 
about  eight  inches  from  the  top  of  the  mattress, 
tuck  them  in  at  the  bottom  and  arrange  the  sides 
in  the  same  manner  as  the  sheet. 

Put  on  the  spread,  have  its  upper  edge  on  a  line 
with  the  top  of  the  mattress.  Tuck  it  in  at  the 
bottom,  fold  the  corners  neatly. 

If  necessary,  put  clean  cases  on  the  pillows, 
shake  them,  get  their  corners  into  those  of  their 
cases,  press  them  with  your  arms,  on  a  table,  until 
they  are  perfectly  flat  and  then  put  them  on  the 
bed. 

To  turn  down  the  upper  covers,  when  the  patient 
is  ready  to  go  to  bed :  Turn  the  top  edge  of  the 
spread  over  the  blankets  and  the  top  of  the  sheet 
over  this.  If  the  covers  have  been  tucked  under 
the  mattress,  set  them  free  and  to  do  this,  without 
loosening  the  under  sheets,  keep  one  hand  grasping 


52  Nursing  Methods 

them  and  the  edge  of  the  mattress,  raising  the 
latter  very  slightly,  while  you  pull  out  the  upper 
covers  with  the  other  hand.  Then  turn  down  the 
covers;  there  are  two  common  methods  of  doing 
this:  (i)  Grasp  the  upper  edge  of  the  clothes  on 
each  side  of  the  bed  between  your  thumbs  and 
fingers  and  fold  them  down  to  the  center  of  the 
bed,  draw  the  upper  half  of  this  fold  upward, 
making  a  double  fold  with  the  upper  edge  of  the 
clothes  facing  the  head  of  the  bed.  (2)  At  one 
side  turn  back  the  upper  half  of  the  clothes  in  a 
triangular  fold.  This  will  mean  that  the  upper 
edge  of  the  clothes  will  lie  along  the  edge  of  the 
mattress  at  the  side  farthest  from  you. 

Demonstration  4 
Changing  the  Sheets  with  the  Patient  in  Bed 

Equipment  for  demonstration : 

The  same  as  for  Demonstration  3  plus  two  ex- 
tra sheets,  two  nightgowns  and  a  "patient."  The 
doll  may  be  used  for  the  patient,  but  it  is  very 
much  better  for  the  pupils  to  take  turns  being 
patient  for  demonstrations  of  this  kind.  Have  the 
"patient"  in  bed. 

Procedure : 

i.  Be  sure  that  everything  necessary  for  the 
work  is  at  hand  and  arrange  the  table  and  chairs, 
as  in  Demonstration  3,  for  the  reception  of  clothes 
taken  from  the  bed. 


Bed-Making  53 

2.  Take  off  the  spread,  fold  it,  and  put  it  where 
it  will  not  get  crushed.    If  there  are  two  blankets 
on  the  bed,  remove  the  upper  one. 

3 .  Loosen  the  bedclothes  on  all  sides.   To  do  so, 
raise  the  mattress  with  one  hand  and  draw  the 
clothes  out  with  the  other,  so  as  to  avoid  risk  of 
jarring  the  patient  and  tearing  the  clothes. 

4.  Change  the  top  sheet.    To  do  this,  place  a 
clean  sheet  over  the  blanket  that  remains  on  the 
bed,  cover  this  with  the  other  blanket ;  turn  about 
ten  inches  of  the  sheet  over  this  blanket  at  the  top ; 
if  the  patient  is  not  too  ill  she  can  usually  be  asked 
to  hold  the  upper  edge  of  these,  otherwise  they  can 
be  tucked  under  her  shoulders  or  under  the  pillow 
to  retain  them  in  place;  then,  standing  near  the 
foot  of  the  bed,  pass  your  hand  under  the  clean 
sheet,  take  the  covers  that  are  to  be  removed  near 
their  center  and  draw  them  out.     Never  expose 
the  patient  while  doing  this.    Separate  sheet  and 
blanket  and  place  them  across  the  chairs. 

5.  Fold  the  sides  of  the  blanket  and  top  sheet 
up  over  the  patient,  leaving  the'  fold  just  long 
enough  to  cover  her  if  she  is  turned.    This  answers 
a  threefold  purpose:  it  gives  a  neat  appearance; 
the  clothes  are  not  in  your  way  while  you  work; 
it  keeps  the  patient  as  warm  as  before  the  upper 
blanket  was  removed. 

6.  Draw  the  patient  to  one  side  of  the  bed. 

7.  Arrange  the  pillows.    To  do  this:    Slip  one 
arm  under  the  patient's  neck  and  far  shoulder, 
letting  her  head  rest  on  your  arm  (see  Fig.  3) ;  raise 


54  Nursing  Methods 

her  slightly  and  with  your  free  hand  remove  the 
pillows,  pulling  them  outward.  It  is  usually  easier 
to  remove  them  one  at  a  time.  Before  replacing 
the  pillows,  shake  them  and  see  that  their  corners 
fit  into  those  of  the  cases.  Do  not  let  them  rest  on 
the  bed  while  doing  this.  To  replace  them,  put 
them  one  on  top  of  the  other,  at  the  head  of  the 
bed  close  to,  but  on  the  far  side  of,  the  patient; 
raise  the  patient  as  when  removing  the  pillows; 
pass  your  free  hand  back  of  her  and,  taking  hold 
of  the  lower  pillow,  draw  both  pillows  into  place. 
Arrange  them  so  that  the  patient  rests  comfort- 
ably. Do  not  allow  an  unconscious  or  helpless  pa- 
tient's head  to  be  thrown  forward  on  the  chest,  for 
such  a  position  will  interfere  with  proper  breathing. 
8.  Change  the  nightgown.  Important  points 
to  remember  when  doing  so  are : 

(1)  When  a  patient  is  weak  or  helpless,  if  the 
sleeves  of  the  gown  do  not  slip  off  readily,  slip  one 
of  your  hands  through  an  armhole,   grasp  the 
patient's  arm  about  the  elbow,  and,  bending  it 
slightly,  draw  it  backward  while,  with  your  other 
hand,  you  pull  the  sleeve  either  at  the  armhole  or 
the  wrist. 

(2)  Get  a  weak  patient's  arm  into  the  sleeve  of  a 
gown  by  putting  your  arm  through  the  lower  open- 
ing, grasping  her  hand,  including  her  thumb,  and 
drawing  the  arm  through  the  sleeve. 

(3)  If  an  arm  is  injured,  remove  the  sleeve  from 
that  arm  last,  but  put  the  sleeve  of  the  clean  gown 
on  it  first. 


Bed-Making  55 

(4)  Be  sure  that  the  gown  is  well  pulled  down 
and  free  from  creases.  If  the  gown  opens  down  the 
back,  it  is  usually  better,  especially  if  the  patient 
is  weak  or  helpless,  not  to  put  the  lower  ends  under 
her  as  they  are  likely  to  become  wrinkled. 

Procedures  in  changing  the  nightgown: 

Method  i.  If  the  gown  opens  down  the  back, 
remove  one  sleeve  of  the  gown  to  be  discarded  and 
put  on  the  corresponding  sleeve  of  the  fresh  one. 
Slip  the  fresh  gown  across  the  chest,  under  the 
soiled  one,  to  prevent  exposure,  and  change  the 
sleeves  in  the  same  way  as  the  first  ones. 

Method  2.  To  remove  a  closed  gown,  have  the 
patient  lie  on  her  back  with  her  knees  flexed ;  pull 
the  gown  up  as  far  as  possible,  then,  if  the  patient 
is  strong  enough,  have  her  raise  her  thighs  slightly; 
if  she  is  not  sufficiently  strong,  place  one  of  your 
hands  under  her  buttocks  and  raise  her  while  you 
draw  up  the  gown  with  the  other  hand;  raise  her 
shoulders  if  necessary.  When  the  gown  has  been 
gathered  up  to  the  shoulders,  slip  one  of  your  hands 
through  the  upper  armhole  of  one  of  the  sleeves, 
grasp  the  patient's  arm  below  the  elbow,  bend  it 
slightly  while,  with  the  other  hand,  you  draw  off 
the  sleeve ;  slip  the  gown  over  the  head  and  off  the 
other  arm. 

The  best  way  to  put  on  the  gown  depends  upon 
its  make.  If  it  is  narrow  at  the  top  and  does  not 
unbutton  it  can  sometimes  be  put  on  most  easily  in 
about  the  same  manner  as  the  soiled  one  was  re- 
moved except  that  the  order  of  things  is  reversed; 


56  Nursing  Methods 

thus  one  arm  is  drawn  into  a  sleeve,  then  the  gown 
is  put  over  the  head  and  the  other  arm  drawn  into 
its  sleeve  and  the  gown  pulled  down,  raising  the 
patient  while  doing  so  in  the  same  manner  as  when 
removing  the  gown. 

Method  3.  If  the  gown  is  loose  at  the  top  and 
the  opening  is  a  fair  size,  it  is  best  put  on  by  gather- 
ing it  up  loosely  and  slipping  it  over  the  head  and 
then  drawing  first  one  and  then  the  other  arm 
through  a  sleeve.  The  gown  is  pulled  down  as  in 
Method  2. 

9.  Sweep  all  crumbs  from  the  bed  on  the  side  at 
which  you  are  standing,  using  either  your  hand  or 
a  folded  towel.    Do  likewise  on  the  other  side  of 
the  bed  when  you  go  there  to  adjust  the  sheets. 
Look  for  crumbs  between  the  sheets.     This  proce- 
dure should  be  carried  out  even  when  the  sheets 
are  changed,  for  otherwise  the  crumbs  may  be 
scattered  on  the  mattress. 

10.  Change  the  under  and  draw  sheets.    To  do 
so  go  to  the  side  of  the  bed  farthest  from  the 
patient. 

Turn  back  the  draw  sheet  and  protector,  so  that 
they  will  be  out  of  your  way  while  you  adjust  the 
under  sheet,  if  they  are  wide,  turn  down  their 
upper  ends  so  that  they  will  not  come  near  the 
patient's  face. 

Roll  one  side  of  the  under  sheet  close  to  the 
patient's  side. 

Gather  one  side  of  the  fresh  sheet  to  about  its 
center  (let  it  rest  on  a  table  or  chair  while  doing  so, 


Bed-Making  57 

not  on  the  patient's  bed)  and  place  the  gathered 
portion  next  the  roll  of  the  soiled  sheet.  Be  sure 
that  the  sheet  is  perfectly  straight  and  that  you  are 
leaving  an  equal  amount  to  tuck  in  on  both  sides. 

Tuck  in  the  sheet  on  the  side  at  which  you  are 
standing. 

Adjust  the  protector  on  this  side. 

Treat  the  draw  sheet  in  the  same  manner  as  the 
under  sheet  with  the  exception  of  leaving  it  longer 
at  one  side  than  the  other. 

Turn  the  patient  and  draw  her  on  to  the  fresh 
sheets  and  go  to  the  other  side  of  the  bed. 

Remove  the  soiled  sheets. 

Stretch  the  under  sheet  until  it  is  perfectly  free 
from  wrinkles  and  then  tuck  the  side  and  ends 
under  the  mattress  in  the  same  manner  as  when 
making  a  closed  bed. 

Adjust  the  protector  on  this  side  and  treat  the 
draw  sheet  in  the  same  manner  as  in  Demonstra- 
tion 3. 

1 1 .  Draw  the  patient  to  the  center  of  the  bed. 

12.  Arrange  the  upper  sheet  and  blankets  in 
position.    Have  the  upper  edges  of  the  blankets 
under  the  patient's  chin  and  leave  enough  of  the 
sheet  to  turn  eight  inches  over  the  blanket.    Tuck 
in  first  the  top  sheet  and  then  the  blankets  at  the 
foot,  being  careful  to  keep  them,  especially  the 
sheet,  loose  over  the  patient's  feet. 

13.  Arrange  the  pillows  so  that  the  patient  lies 
comfortably. 

14.  Put  on  the  spread.    Arrange  it  at  the  foot 


58  Nursing  Methods 

and  sides  as  when  making  a  closed  bed,  but  fold  it 
back  under  the  blankets  at  the  top  and  turn  the 
sheet  over  it. 

(N.  B.  These  details  should  be  carried  out  in 
the  order  in  which  they  are  given,  since,  if  there  are 
crumbs  in  the  upper  clothes,  nightgown,  or  pillows, 
they  are  likely  to  be  left  in  the  bed  if  these  articles 
are  changed  after  the  under  sheets.) 

15.  Remove  all  soiled  clothes  and  the  appli- 
ances used  for  the  work.  Replace  anything  that 
has  been  moved  from  its  regular  place.  Be  sure 
that  the  surroundings  are  in  order  and  that  the 
"patient"  is  comfortable. 


CHAPTER  IV 
Preparation  of  a  Patient  for  the  Night 

Demonstration  5:  Preparation  of  a  patient  for  the  night,  in- 
cluding rubbing  the  back,  cleaning  the  teeth,  and  doing  the  hair. 
How  to  give  and  remove  a  bedpan. 

Demonstration  5 
Preparation  of  a  Patient  for  the  Night 

Equipment  for  demonstration : 

Toilet  basin  containing  hot  water.  Soap.  Hand 
towel  and  bath  towel.  Washcloth.  Tooth  paste. 
Toothbrush,  or  substitute;  a  strip  of  whalebone 
covered  at  one  end  with  absorbent  cotton  is  an  excel- 
lent substitute  for  a  toothbrush  when  the  patient  is  too 
ill  to  clean  her  own  teeth,  because  the  whalebone  can 
be  bent  to  follow  the  contour  of  the  mouth.  Aicunol, 
50  per  cent.  Talcum  powder.  Either  the  doll  or, 
preferably,  a  pupil  in  bed  to  act  as  patient. 

Procedure : 

1 .  Place  a  chair  at  the  foot  of  the  bed. 

2.  Draw  the  patient  to  the  side  of  the  bed. 

3.  Loosen  the  nightgown  at  the  neck. 

4.  Place  the  towel  under  the  chin;  wash  and 
dry  the  face,  neck,  in  and  around  the  ears. 

59 


60  Nursing  Methods 

5.  Place  the  towel  so  that  one  end  will  be  under 
the  basin  when  it  is  placed  where  one  of  the  pa- 
tient's hands  can  rest  in  it.    Arrange  the  basin  in 
such  position  and  wash  her  hand,  squeezing  water 
from  the  cloth  through  the  fingers.    Dry  this  hand 
and  then  treat  the  other  one  in  like  manner. 

6.  Place  the  towel  under  the  chin  and  clean  the 
teeth.     To  do  this,  moisten  the  toothbrush  with 
water,  put  some  paste  on  it,  move  the  brush  back 
and  forward  over  the  teeth,  then  tell  the  patient  to 
hold  her  teeth  apart  and  brush  from  the  gum  down- 
ward on  the  upper  jaw  and  from  the  gum  upward 
on  the  lower  jaw  (never  brush  toward  the  gum) 
in  front  and  at  the  back  of  the  teeth.    Wet  the 
brush  as  often  as  necessary  by  pouring  water  over 
it,  letting  the  water  run  into  the  empty  bowl. 
Brush  off  the  paste.    If  the  patient  is  strong  enough 
to  rinse  her  mouth  and  gargle  her  throat  raise  her 
head  and  let  her  take  a  mouthful  of  water,  lower 
her  head,  place  the  small  basin  where  it  will  be 
convenient  for  her  to  eject  the  water  into  it.    If 
the  substitute  for  a  toothbrush  suggested  with  the 
equipment  is  used,  wash  your  hands  before  putting 
the  cotton  on  the  whalebone  and,  when  removing 
it,  do  not  touch  it  with  your  fingers;  you  can  cover 
it  with  a  piece  of  paper  and  then  draw  it  off. 

7.  Turn  down  the  spread  and  upper  blanket 
over  the  foot  of  the  bed  and  chair. 

8.  Turn  the  sides  of  the  remaining  blanket  and 
upper  sheet  over  the  patient  as  in  Demonstration 

4- 


Preparation  for  the  Night        61 

9.  Wash  and  then  rub  with  (a)  alcohol,  and  (b) 
powder  the  axillae,  back,  and  hips,  and  any  other 
parts  necessary  for  the  prevention  of  pressure  sores 
or  chafing. 

To  wash  the  back :  If  possible  have  the  patient 
on  her  side ;  if  she  is  weak  turn  her  toward  you  as 
you  can  then  support  her  with  one  arm  while  you 
work.  Turn  back  the  upper  corner  of  the  bed- 
clothes enough  to  have  them  out  of  your  way  but 
not  enough  to  expose  the  patient  unnecessarily. 
Protect  the  bed  by  putting  the  bath  towel  close  to 
the  patient's  back.  Wash  first  with  soap  and  then 
clear  water.  Do  the  neck  and  shoulders  first.  Dry 
each  part  as  soon  as  you  finish  washing  it. 

To  rub  the  back:  Pour  a  little  alcohol  on  your 
hand  and  rub  it  on  the  back  around  the  shoulders 
and  neck,  then  place  your  hand  firmly  on  the  skin 
and  move  the  flesh  on  the  bone,  repeat  until  you 
have  gone  over  the  entire  back  and  hips;  pay 
special  attention  to  any  parts  that  look  red.  Pour 
a  little  powder  on  your  hands  and  rub  it  over  the 
back ;  do  not  use  much. 

10.  Shake  the  nightgown  to  make  sure  that 
there  are  no  crumbs  caught  in  it. 

1 1 .  Go  to  the  side  of  the  bed  farthest  from  the 
patient.    If  there  are  crumbs  in  the  bed  brush  them 
out  with  a  folded  towel. 

12.  Loosen  the  draw  sheet  and,  if  it  is  wrinkled, 
the  under  sheet.    If  the  under  sheet  has  been 
loosened,  stretch  it  and  tuck  it  under  the  mattress 
again.    Tuck  the  end  of  the  draw  sheet  under  the 


62  Nursing  Methods 

mattress  but  leave  a  portion  loose  and  move  this 
up  against  the  patient's  back  or,  if  possible,  some- 
what under  her. 

13.  Draw  the  patient  to  the  center  of  the  bed. 

14.  Go  to  the  other  side  of  the  bed.    If  there 
are  any  crumbs,  brush  them  off  with  the  folded 
towel. 

15.  Raise  the  mattress  with  one  hand  and,  with 
the  other,  draw  out  the  sheets.     In  turn  stretch 
each  sheet  until  it  is  perfectly  free  from  wrinkles 
and  then  tuck  the  free  portion  under  the  mattress. 

1 6.  If  necessary,  tighten  the  under  sheet  at  the 
top  and  bottom  of  the  bed. 

17.  Arrange  the  nightgown  so  that  it  is  free 
from  wrinkles  and  fasten  it. 

1 8.  Arrange  the  upper  covers  in  the  usual 
manner. 

19.  Comb  and  brush  the  "  patient's "  hair. 
To  do  this:  Place  a  towel  under  the  "patient's" 
head  and  across  the  shoulder  nearest  to  you.    Set 
the  hair  free,  part  it  in  the  center  from  the  forehead 
to  the  nape  of  the  neck  and  be  sure  to  make  the 
part  clear.     Comb  and  then  brush  the  strand  of 
hair  on  the  side  at  which  you  are  standing.    If  it  is 
tangled,  begin  to  comb  at  the  free  end  and,  while 
you  are  loosening  the  snarl,  hold  the  hair  between 
the  tangle  and  the  head.    Braid  this  strand,  be- 
ginning close  behind  the  ear;  be  sure  that  the  hair 
between  the  part  and  the  braid  is  loose  enough  to 
avoid  pulling  the  hairs,  but  not  more  so.    Go  to 
the  other  side  of  the  bed  and  repeat  the  procedures. 


Preparation  for  the  Night       63 

If  the  "patient"  does  not  wish  to  have  her  hair 
done  in  two  braids,  instead  of  braiding  the  second 
strand,  undo  the  first  and  dress  the  hair  as  required. 
Two  reasons  for  arranging  the  hair  in  two  braids 
are  (i)  it  is  more  comfortable  for  the  patient  if 
she  has  to  lie  on  her  back;  (2)  it  is  then  easier  to 
brush  and  comb  it  and  to  keep  it  free  from  tangles. 

20.  Be  sure  that  the  patient  is  comfortable. 

21.  Remove  all  appliances  used  and  tidy  the 
surroundings. 

22.  Make  sure  that  the  ventilation  is  adequate 
and  the  temperature  of  the  appropriate. 

To  Give  and  Remove  the  Bedpan 

Another  item  that  is  usually  essential  in  the 
preparation  of  a  patient  for  the  night's  rest  is  to 
give  her  a  bedpan.  This  procedure  cannot  very 
well  be  demonstrated  in  class  but,  some  idea  of 
how  to  carry  it  out  can  be  gained  from  the  follow- 
ing description : 

If  the  pan  is  cold,  warm  it.  This  is  usually  done 
by  letting  hot  water  run  over  it.  Be  sure  that  it  is 
dry  before  you  take  it  to  the  patient.  Take  with  it 
a  cover  (this  is  usually  either  double-faced  rubber 
or  heavy  washable  material),  toilet  paper,  and,  if 
the  patient  expects  to  have  a  defecation,  a  sheet 
that  is  kept  for  this  purpose. 

If  possible,  flex  the  patient's  knees  and  place 
her  feet  firmly  on  the  bed. 

Place  the  pan  on  the  bed  near  the  patient. 


64  Nursing  Methods 

Put  your  hand  which  is  nearest  the  head  of  the 
bed  under  the  buttocks  (stand,  if  practicable,  at 
the  side  of  the  bed  which  will  allow  of  this  being 
your  left  hand) ;  raise  the  patient  and  slip  the  pan 
into  position.  Make  sure  that  it  is  well  placed. 

If  the  patient  expects  to  have  a  defecation  put 
the  sheet,  folded,  under  the  upper  covers,  over  the 
patient's  legs  and  around  the  sides  of  the  bedpan 
(this  helps  to  prevent  an  odor  permeating  the  bed), 
and  get  two  compresses  of  gauze  or  soft,  old  muslin 
and  a  basin  of  hot  water. 

When  the  patient  is  ready  to  have  the  pan  re- 
moved, if  her  knees  are  not  flexed,  flex  them; 
arrange  the  bedcovers  so  that  they  will  be  out  of 
your  way,  but  do  not  expose  the  patient.  If  the 
patient  is  not  able  to  use  the  paper,  do  so  for  her. 
Put  one  hand  under  the  buttocks  and  raise  the 
patient  as  when  giving  her  the  pan.  It  is  most 
important  to  do  this  for,  if  you  neglect  it,  even 
when  the  patient  can  move  without  your  help,  the 
pan  may  be  jerked  and  some  of  its  contents  spilled. 
Cover  the  pan  at  once. 

If  the  patient  had  a  defecation  put  a  compress 
under  the  rectum  and  then  wash  around  this  part. 
Use  the  compress  placed  under  her  for  drying. 

If  the  defecation  is  very  odorous  it  is  better  to 
remove  the  pan  before  washing  the  patient,  but, 
otherwise,  as  the  washing  need  only  take  a  few 
seconds,  it  can  be  done  first. 

Wash  the  compresses  used  and  keep  them  for 
the  same  purpose. 


Preparation  for  the  Night        65 

Never  empty  a  bedpan  without  noting  its  con- 
tents and  if  this  has  the  slightest  unusual  appear- 
ance empty  it  into  a  vessel  in  which  it  can  be  kept 
tightly  covered  and  show  it  to  the  doctor. I 

After  emptying  the  pan  flush  it  first  with  cold2 
and  then  with  hot  water  and  be  sure  that  it  is 
absolutely  clean. 

1  Feces  represents  (i)  the  food  material  that  has  escaped  diges- 
tion; (2)  secretions  from  the  glands  and  lining  membrane  of  the 
digestive  tract  and  associated  organs;  (3)  bacteria  that  have  been 
in  the  alimentary  canal  and  their  products;  thus  abnormal  condi- 
tions of  digestion  and  of  the  lining  of  the  canal  and  of  the  liver 
and  pancreas  can  often  be  ascertained  by  examination  of  this 
excreta.    The  liver  and  pancreas  manufacture  secretions  neces- 
sary for  digestion  and,  therefore,  if  they  are  diseased  digestion 
will  not  be  normal. 

The  urine  contains  the  greater  part  of  the  waste  products  of 
metabolism,  except  the  CO2,  and  changes  will  occur  in  the 
nature  of  these  when  metabolism  is  defective;  also,  if  there  are 
foreign  substances  in  the  blood,  such  as  medicine,  toxins  of 
bacteria,  etc.,  they  will  be  eliminated  chiefly  in  the  urine,  as  will 
be  also  material  normal  or  abnormal,  thrown  off  by  the  cells  or 
membrane  lining  the  urinary  tract  (kidneys,  ureters,  bladder, 
urethra).  Thus  the  physician  can  often  obtain  valuable  informa- 
tion regarding  the  patient's  condition  by  examination  of  the  urine. 

2  Both  urine  and  feces  contain  material  that  is  coagulated  by 
heat  and  thus  if  hot  water  is  poured  into  the  pan  first  the  latter 
will  be  harder  to  get  clean  and  to  free  from  odor. 


CHAPTER  V 
Essentials  for  a  Patient's  Comfort 

Principles  involved  in  making  a  patient  comfortable  under 
varying  conditions,  including  when  she  is  out  of  doors  in  cold 
weather.  Causes  and  prevention  of  pressure  sores  and  chafing. 
Demonstration  6:  Methods  of  making  a  patient  comfortable 
when:  (i)  Lying  in  different  positions;  (2)  sitting  up  in  bed. 
Demonstration  7:  Preparing  a  patient  to  get  out  of  bed  and 
making  her  comfortable  in  a  chair. 

The  equipment  for  Demonstration  6  is  given  on 
page  82,  and  for  Demonstration  7  on  page  86. 

Essentials  for  a  Patient's  Comfort 

People,  when  ill,  are,  as  a  rule,  more  easily 
irritated  and  worried  by  trifles  than  when  they  are 
well,  because,  normal  brains  possess  the  power  of 
directing  thought  so  as  to  restrain  any  tendency 
to  be  too  easily  influenced  by  slight  annoyances, 
but  the  conditions  existing  in  illness  will  affect  the 
brain  as  well  as  other  organs  and  it  is  just  as 
impossible  for  a  brain  that  is  in  an  abnormal  con- 
dition to  function  properly  as,  for  examples,  a 
muscle  or  the  stomach.  Unfortunately,  there  are 
few  things  worse  for  the  brain  than  mental  irrita- 
tion and  worry  and,  especially  as  all  the  organs  of 

66 


Essentials  for  a  Patient's  Comfort  67 

the  body  are  more  or  less  under  the  control  of  the 
nervous  system  and  their  functioning  thus  likely 
to  be  interfered  with  when  this  system  is  abnormal, 
the  prevention  of  anything  that  will  induce  mental 
irritation  is  one  of  the  very  essential  principles  of 
nursing. 

For  this  reason  (i)  a  sick  person  should  not  be 
told  anything  that  will  be  likely  to  annoy  or  worry 
her;  (2)  her  wishes  should  be  complied  with  as  far 
as  possible  and,  when  they  clash  with  what  seems 
right,  the  decision  should  be  left  to  the  doctor  or 
nurse;  (3)  all  sources  of  physical  irritation  are  to 
be  avoided,  examples  of  these  are : 

1.  Excessive  heat  or  excessive  cold. 

2.  Annoying  noises  and  lights. 

3.  Lack  of  comfortable  support  with  pillows, 
or  when  being  moved. 

4.  Crumbs  in  the  bed. 

5.  Wrinkles  in  the  sheet,  nightgown,  etc. 

6.  Being  obliged  to  remain  too  long  a  time  in 
one  position. 

7.  Weight  of  the  bedcovers  upon  the  feet  or  a 
painful  part. 

8.  Dampness  of  the  bedclothes  or  skin. 

9.  Excessive  pressure  upon  a  part  by  a  splint, 
bandage,  or  other  appliance. 

Pressure  sores:  The  causes  of  discomfort  just 
mentioned,  with  the  exception  of  the  four  first  ones, 
are  also  to  be  avoided  because  of  their  tendency  to 
induce  ulceration  or  breaking  down  of  tissue  known 
as  pressure  sores  or  bedsores.  They  do  this 


68  Nursing  Methods 

because  the  cells  of  body  tissues  depend  upon 
material  derived  from  the  lymph1  for  their  nourish- 
ment and  repair2  and,  when  the  blood  is  not  being 
forced  through  the  blood-vessels  as  vigorously  as 
under  normal  conditions,  even  slight  pressure  will 
interfere  with  the  flow  in  the  small  vessels  of  the 
skin,  consequently,  the  blood  remains  in  the  vessels 
of  the  area  after  it  has  lost  its  nutritive  supply 
causing  congestion  and  hindering  the  inflow  of 
fresh  blood. 

Crumbs  and  wrinkles  in  the  sheets,  etc.,  may  not 
only  cause  pressure,  but  they  also  rub  or  chafe 
the  skin  and  may  cause  it  to  break,  and  moisture, 
even  such  as  may  be  present  as  the  result  of  ex- 
cessive perspiration,  tends  to  help  this  effect.  If 
the  skin  breaks,  bacteria,  which  are  always  present, 
will  get  into  the  deeper  tissues  of  the  part  and  help 
in  its  disintegration. 

The  parts  of  the  body  in  which  pressure  sores 

1  Lymph  is  the  name  given  to  the  fluid  which  passes  from  the 
blood  through  the  small  blood-vessels  known  as  capillaries. 
Lymph  contains  (i)  the  water  and  food  material  (absorbed  from 
the  intestines)  which  the  cells  need  for  their  nourishment;  (2) 
the  oxygen  (absorbed  while  the  blood  circulates  in  the  lungs) 
which  is  required  for  those  chemical  changes  in  material  brought 
by  the  lymph,  that  give  rise  to  heat  and  energy  and  produce  the 
COa  and  other  waste  matter  that  passes  into  the  lymph  vessels 
and  blood-vessels  and  is  carried  to  the  lungs  and  kidneys  to  be 
excreted;  (3)  substances  manufactured  in  body  glands  and  ab- 
sorbed by  the  blood  which  promote  the  chemical  changes  that 
occur  in  the  tissues;  (4)  substances  that  protect  the  body  from 
bacteria  and  their  toxins. 

*  Material  of  the  tissue  cells  is  being  constantly  destroyed  and 
must  be  replaced  by  substances  from  the  lymph. 


Fig.  8.     Changing  the  under  sheet. 


Essentials  for  a  Patient's  Comfort  69 

will  form  most  rapidly  are  the  buttocks  and  over 
bony  prominences,  such  as  the  end  of  the  spine, 
the  heels,  shoulder  blades,  elbows,  and,  on  children, 
the  back  of  the  head. 

Chafing — i.e.,  friction — will  cause  breaks  in  the 
skin  very  readily,  even  when  there  is  no  pressure, 
if  the  skin  is  allowed  to  remain  damp.  It  occurs 
most  frequently  in  parts  where  two  surfaces  of  the 
body  come  in  contact,  as  between  the  buttocks  or 
under  the  breasts.  It  is  most  likely  to  occur  in 
stout  elderly  people  and  young  children.  A  similar 
condition  will  occur  on  the  buttocks  of  infants 
whose  diapers  are  not  properly  attended  to,  this 
will  be  discussed  in  Chapter  IX. 

One  of  the  first  signs  that  harmful  pressure  is 
being  made  upon  a  part  is  a  deep  redness  of  the 
skin.  This  is  due  to  the  congestion  resulting  from 
the  interference  with  the  circulation  in  the  area  as 
described  above.  There  is  also  likely  to  be  pain, 
especially  when  the  pressure  is  due  to  a  tight  or 
improperly  adjusted  bandage  or  splint,  but  the 
pain  does  not  always  persist,  either  because  the 
pressure  interferes  with  the  passage  of  nerve- 
impulses1  or  because  the  nervous  mechanism  in- 

1  Sensations  are  perceived  or  interpreted  in  the  brain  and  not 
at  the  outer  surface  of  the  body,  if,  for  example,  a  person  cuts  her 
finger,  the  sensation  produced  is  not  really  in  the  finger,  but  in 
the  brain.  A  proof  of  this  is  that  when  either  the  sensory  nerves 
leading  from  (for  example)  a  person's  legs  to  the  spinal  cord,  or 
the  fibers  extending  up  the  cord  to  the  brain  are  destroyed,  pain 
in  the  legs  will  cease  to  be  felt,  the  legs  could  even  be  amputated 
without  causing  pain. 


70  Nursing  Methods 

volved  becomes  accustomed  to  the  stimulus  and 
ceases  to  be  affected  by  it.1  Therefore,  if  a  part 
remains  red,  even  though  there  is  no  pain,  means 
must  be  taken  to  reduce  pressure.  Redness  of  the 
skin  is  also  characteristic  of  chafing,  because  irrita- 
tion of  a  part,  from  any  cause  results  in  dilation 
of  the  blood-vessels2  in  the  area  affected,  which 
interferes  with  the  flow  of  blood  through  these 
vessels  and  congestion  and,  consequently,  redness 
of  the  skin  results.  Other  common  consequences 
of  chafing  are  eruptions  of  pimples  and  itching  of 
the  skin. 

The  means  of  preventing  pressure  sores  and 
chafing  are:  To  protect  threatened  parts  from 
pressure  and  to  keep  the  skin  clean  and  dry. 

Excessive  bed-pressure  can  be  relieved  by 
changing  the  patient's  position  frequently  and  by 
putting  pads  or  rings  under  areas  which  show  the 
effects  of  pressure  and,  when  a  patient  has  to  lie 
for  a  long  time  in  the  same  position,  an  air-mattress3 

1  Mild  stimuli  often  cease  to  be  perceived  after  a  time.     A 
common  example  of  this  is  the  rapidity  with  which  we  cease  to  be 
aware  of  an  odor  that  we  perceived  on  entering  a  room,  except 
when  the  odor  is  very  strong. 

2  It  is  not  always  known  why  irritation  causes  dilation  of  blood- 
vessels because  local  dilation  can  be  induced  in  at  least  three 
ways,  namely:  (i)  Depression  of  the  walls  of  the  vessels  by  chemi- 
cal substances  formed  in  the  tissues  when  they  are  active;  (2)  de- 
pression of  the  nerves  which  carry  the  impulses  to  the  blood- 
vessels that  keep  them  in  a  state  of  contraction;  (3)  stimulation 
of  those  nerves  which  transmit  the  impulses  to  the  blood-vessels 
that  cause  their  dilation. 

3  A  sack  that  when  air  is  pumped  into  it  assumes  the  shape  of 
a  mattress. 


Essentials  for  a  Patient's  Comfort  71 

should  be  obtained  if  possible,  for  this,  if  it  is 
properly  prepared, I  will  yield  to  the  weight  of  the 
body  and  thus  make  less  pressure  against  it  than 
an  ordinary  mattress. 

Pressure  and  friction  by  splints  and  the  like  will 
be  avoided  by  padding  the  appliances  and  adjust- 
ing them  properly,  this  will  be  described  in  a  sub- 
sequent Chapter  XIV.  Of  course  any  appliance 
put  on  by  a  doctor  is  not  to  be  changed  without  his 
permission,  but  it  must  be  realized  that  a  bandage, 
etc.,  may  become  too  tight  or  too  loose  even  when 
properly  applied  because  of  increase  or  reduction 
of  inflammation  in  the  part  to  which  it  is  applied. 

The  usual  means  employed  to  keep  the  skin  in 
good  condition  are :  (i)  Washing  it  very  gently  at 
least  twice  a  day  with  warm  water  and  a  little  pure 
soap,  using  a  very  soft  cloth  and  patting,  not 
rubbing,  red  areas;  (2)  applying  alcohol2  and,  after 
this  has  evaporated,  a  little  powder  to  all  threat- 
ened parts  after  they  have  been  washed  and,  if  the 
areas  are  very  red,  as  often  as  every  two  or  three 
hours ;  (3)  massaging  the  parts — this  is  done  while 
the  alcohol  is  evaporating.  While  massaging, 
keep  the  fingers  still  on  the  part  and  move  the 
tissues,  on  no  account  rub  the  skin  either  when 
massaging  or  washing  it,  for  doing  so  may  break  it. 

Adequate  support,  as  stated  on  page  67,  is  very 

1  Enough  air  is  to  be  pumped  into  it  to  keep  the  patient  from 
touching  the  springs  of  the  bed,  but  not  so  much  that  the  mattress 
becomes  firm  or  inflexible. 

a  Alcohol  tends  to  dry  and  harden  the  skin. 


72  Nursing  Methods 

essential  for  comfort  when  a  person  is  ill.  It  is  hard 
for  a  person  who  has  never  been  ill  or  observed  very 
ill  patients  to  realize  how  thorough  support  must 
be  to  prevent  a  sense  of  strain  and  tiredness.  It 
may,  for  example,  be  almost  impossible  for  a  weak 
person  to  lie  on  her  side  unless  pillows  are  so  ar- 
ranged that  she  can  rest  against  them  and,  in 
almost  any  position,  small  pillows  may  be  needed 
under  the  curve  at  the  waistline.  If  the  legs  are 
flexed,  support  will  be  required  under  the  knees 
and,  even  when  sitting  up  in  bed,  a  patient  is  likely 
to  want  her  legs  flexed  a  great  part  of  the  time  for 
this  relaxes  the  muscles  of  the  abdomen  and  thighs. 
Support  may  also  be  required  to  keep  the  patient 
from  slipping  down  in  bed,  this  is  especially  likely  to 
be  the  case  when  she  is  sitting  up  or  when  her  condi- 
tion makes  it  necessary  to  raise  the  head  of  the  bed. 
It  would  be  quite  impossible  to  give  exact  de- 
scriptions of  arrangements  of  pillows  that  would  be 
comfortable  to  all  patients  for  so  much  depends 
upon  the  patient's  condition  and  the  size  of  the 
pillows.  The  accompanying  illustrations  give  some 
idea  of  methods  of  arrangement  with  the  patient 
in  different  positions.  In  most  of  these,  it  will  be 
noticed,  there  is  only  one  pillow  under  the  head  for, 
except  when  the  patient  is  suffering  from  a  disease 
that  is  associated  with  difficult  breathing  or  other 
condition  requiring  some  special  position,  she,  if 
very  ill,  is  usually  kept  in  as  nearly  a  horizontal 
position  as  possible  for,  as  will  be  seen  in  Chapter 
VII,  this  minimizes  the  work  of  the  heart.  Most 


Essentials  for  a  Patient's  Comfort  73 

convalescent  patients,  however,  especially  during 
the  daytime,  prefer  to  have  a  second  pillow  and, 


Fig.  9.    Dorsal  or  supine  position.     With  the  knees  raised  to 
relax  the  tension  of  the  abdominal  muscles. 

in  such  case,  the  lower  one  should  be  placed  further 
under  the  patient's  shoulders  than  shown  in  Fig.  9 
and  the  upper  one  in  about  the  position  shown  in 
this  illustration. 


Fig.  10.    Prone  position.    The  bedclothes  are  folded  down  to 
show  the  arrangements  of  the  pillows. 

Fig.  9  shows  the  position  a  very  ill  patient  will 
lie  in  the  greater  part  of  the  time  when  a  special 
one  is  not  necessary.  In  Fig.  10  the  patient  is  lying 


74 


Nursing  Methods 


prone  with  a  pillow  under  the  head  and  one  under 
the  chest,  such  a  position  is  sometimes  necessary 
after  surgical  operations,  otherwise,  it  is  usually 
only  a  temporary  one,  but  it  may  afford  relief  to  a 
patient  who  has  been  lying  on  her  back  for  a  long 
time.  In  Figs,  n  and  12  the  pillows  are  placed 


Fig.  II.    Lateral  (side)  position. 


behind  the  patient's  shoulders  and  thighs  and  a 
small  one  under  the  curve  at  the  waistline.  The 
main  difference  in  the  two  illustrations  is  the  pa- 
tient's position,  and  they  are  both  shown  in  order 
to  emphasize  the  fact  that  even  such  slight  change 
of  position  will  afford  relief  to  a  patient  who  is  rest- 
less and  tired  of  staying  in  bed.  In  Fig.  13  the  two 
lower  pillows  are  placed  obliquely,  one  on  each 
side  of  the  patient,  with  a  corner  fitting  into  the 
curve  of  the  back  at  the  waistline  and  the  greater 
part  of  each  pillow  affording  a  support  for  her 
arms,  another  pillow,  a  small  one,  is  placed  at  the 
patient's  back  and  another  behind  her  head.  See 


Essentials  for  a  Patient's  Comfort  75 

Fig.  14.    The  back-rest  in  Fig.  13  is  an  adjustment 
that  is  attached  to  the  bed  and  that  in  Fig.  14  is  a 


Fig.  13.    Patient  supported  in  sitting  position  when  the  bed 
has  an  adjustable  back-rest. 

very  commonly  used  variety,  but  a  chair  with  a 
wide,  flat  back,  placed  upside  down,  with  the  upper 


Fig.  14.     Suitable  arrangement  of  pillows  when  a  sepa- 
rate back-rest  is  used. 

edge  of  the  back  and  the  outer  edge  of  the  seat 
resting  on  the  mattress,  as  shown  in  Fig.  15,  will 


Nursing  Methods 


make  a  fairly  good  substitute.  A  large  pillow 
should  be  placed  lengthwise  against  the  back  of  the 
chair  and  the  other  pillows  arranged  in  front  of 
this. 

The  support  under  the  patient's  knees  in  Fig. 
13  is  what  is  known  as  the  Meinecke  non-slipping 
knee  brace,  it  has  rough  rubber  pads  on  its  under 
surface  which  inhibit  its  slipping.  A  pillow  is 
usually  placed  between  the  brace  and  the  patient's 
thighs.  As  a  substitute  for  such  a  support,  a 
folded  pillow  can  be  used  and,  if  necessary  to  keep 
it  from  slipping,  it  can  be  doubled  and  tied  over  a 
piece  of  strong,  heavy,  preferably  white  twine, 

and  the  ends  of  the 
twine  passed  through 
interstices  of  the  wires 
and  tied  to  the  bars  at 
the  sides  of  the  bed  on 
a  line  with  the  pillow 
and,  if  the  patient  is 
heavy,  to  a  bar  at  the 
head  of  the  bed,  as 
shown  in  Fig.  14. 

A  pillow  or  brace, 
secured  in  place  as  just 
described,  is  a  great 
help  in  preventing  a 
patient  slipping  down 
in  bed  and,  sometimes,  either  in  addition  to,  or 
instead  of  this,  a  brace  is  placed  at  the  feet,  and, 
in  this  location,  a  wooden  box  such  as  can  be 


Fig.  16.    Suitable  table  for  use 
as  described  on  page  81. 


Essentials  for  a  Patient's  Comfort  77 

purchased  for  a  few  cents  at  any  grocery  store, 
will  answer  the  purpose.  If  the  box  is  large 
enough  to  extend  from  the  patient's  feet  to  the 
foot  of  the  bed,  it  will  probably  not  be  necessary 
to  do  anything  to  secure  it  in  place,  otherwise,  a 
small  hole  can  be  made  in  each  side,  twine  passed 
through  these  and  tied  to  the  bed  as  just  described. 
A  pillow  or  folded  pad  will  be  needed  between  the 
box  and  the  patient's  feet. 

A  method  of  supporting  an  injured  leg  is  shown 
in  Fig.  17;  the  leg  is  resting  on  a  padded  splint, 
which  consists  of  a  piece  of  board  a  little  wider  than 
the  leg  and  the  length  of  the  leg  from  the  knee  to 
the  foot  with  a  piece  of  board  the  size  of  the  foot 
nailed  to  the  longer  piece  in  position  to  support  the 
foot ;  the  splint  has  a  hole  in  each  corner  through 
which  twine  is  passed  and  the  latter  is  tied  to  the 
cradle.  Pillows  and  small  pads  are  so  arranged 
that  thigh  and  leg  are  well  supported.  Having  the 
splint  tied  in  this  way  to  the  cradle  and  the  leg 
slightly  raised  allows  of  changing  the  patient's 
position,  changing  the  sheets,  etc.,  without  moving 
the  injured  leg. 

The  weight  of  the  bedcovers,  as  previously 
stated,  may  be  a  source  of  discomfort  to  a  patient. 
Conditions  in  which  this  is  most  likely  to  be  the 
case  are:  (i)  When  the  covers  rest  upon  a  part  of 
the  body  in  which  there  is  pain ;  (2)  when  they  rest 
on  the  toes,  as  when  a  patient  is  lying  on  her  back 
without  her  knees  flexed;  (3)  when  very  heavy 
covers  are  used,  as  when  the  patient  is  sleeping  out 


78  Nursing  Methods 

of  doors  in  cold  weather.  There  are  supports 
commonly  known  as  bed-cradles  that  are  put  under 
the  covers  over  the  part  that  is  to  be  relieved  from 
their  weight,  but,  if  a  cradle  cannot  be  obtained, 
a  wooden  box  with  two  ends  removed  will  answer 
the  purpose. 

When  a  patient  is  sleeping  out  of  doors  in  cold 
weather  it  is  often  quite  a  problem  to  keep  her 
warm  without  using  excessively  heavy  covers. 
Some  helps  to  doing  so  are:  To  put  a  hot-water 
bottle  or  bottles  in  the  bed  (for  care  when  filling 
bags,  see  page  179),  to  provide  flannelet  sheets  and 
nightgown,  instead  of  cotton  ones,  and  to  put  a 
large,  thick,  colored  blanket  (or  two  sewed  together 
if  one  large  enough  cannot  be  obtained)  under  the 
mattress  and  fold  its  sides  and  lower  end  over  the 
mattress  as  shown  in  Fig.  18.  If  the  weight  of  this 
blanket  annoys  the  patient  put  a  large  cradle  or 
other  support  under  it.  This  blanket  must  be 
large  enough  for  the  sides  to  overlap  each  other  for 
a  considerable  distance,  its  main  purpose  being  to 
prevent  cold  air  getting  under  the  covers.  The 
bed  is  made  in  the  usual  way,  except  that,  as  a  rule, 
the  covers  are  tucked  under  the  mattress  at  the 
sides. 

The  proper  support  of  a  patient  while  she  takes 
a  drink  is  another  item  to  be  considered  in  connec- 
tion with  a  patient's  comfort.  A  patient  who  is  at 
all  weak  should  not  be  expected  to  hold  the  glass  or 
drinking  tube.  If  a  glass  or  tube  cannot  be  ob- 
tained from  which  she  can  drink  without  effort 


FULLY  ADJUSTED. 

Fig.  1 8.    Arrangement  of  blankets  when  patient  is  otit  of  doors 
cold  weather. 

79 


8o  Nursing  Methods 

while  lying  down  she  should  be  raised  as  shown  in 
Fig.  20.  It  is  to  be  noticed  that  the  nurse  has  her 
arm  under  the  pillow. 

Amusement  during  convalescence  is  a  very 
important  item  to  be  considered  in  connection 
with  a  patient's  comfort.  The  most  appropriate 
form  of  amusement  will  depend,  of  course,  upon 
the  invalid's  age  and  disposition  and,  if  convales- 
cence is  at  all  prolonged,  it  will  have  to  be  varied, 
e.g.,  work,  games,  and  reading.  Children  es- 
pecially like  to  make  things  and  it  will  be  well  for 
those  who  may  have  to  amuse  them  to  purchase 
one  of  the  many  books  now  to  be  had  describing 
work  that  can  be  done  in  bed,  such  as  making 
paper  articles,  basket  work,  and  bead  work. 

Nearly  everyone  that  is  old  enough  likes  to  be 
read  to  or  to  read.  There  is,  however,  a  very 
important  objection  to  the  latter  form  of  amuse- 
ment and  to  any  kind  of  fine  work,  for  a  person 
who  has  been  ill  for  a  long  time,  namely,  strain  on 
the  eyes.  In  order  to  see  things  near  at  hand, 
especially  small  things  such  as  letters  and  stitches, 
a  change  has  to  be  made  in  the  shape  of  what  are 
known  as  the  crystalline  lens  of  the  eyeballs  (see 
page  1 66)  and  this  change  is  brought  about  by 
very  small  and  delicate  muscles  that  are  attached 
to  the  lens  and  to  the  walls  of  the  eyeballs.  These 
muscles,  after  a  person  has  been  ill  for  any  length 
of  time,  are  likely  to  be  weak  and,  if  kept  in  a  state 
of  contraction  (as  they  are  when  a  person  is  read- 
ing) for  a  long  time,  they  may  be  injured.  Also, 


Essentials  for  a  Patient's  Comfort  81 

unless  the  book  or  work  is  held  about  on  a  level 
with  the  eyes,  the  muscles  th,at  rotate  the  eye 
downward  are  under  constant  strain  and  this,  and 
the  bent  position  in  which  the  head  is  generally 
kept  when  a  book  is  held  too  low,  tend  to  promote 
congestion  in  the  eyes.  Because  of  the  danger  of 
eyestrain,  and  consequent  injury  to  sight,  a 
patient  who  has  been  ill  for  any  length  of  time 
should  not  be  allowed  to  read  or  sew  until  the 
doctor  gives  permission,  and  when  she  is  allowed  to 
read,  her  book  is  to  be  placed  where  it  will  be  nearly 
enough  on  a  level  with  her  eyes  to  make  it  un- 
necessary for  her  to  bend  her  head  and  it  should 
be  supported  on  an  adjustable  table  or  a  sub- 
stitute1 so  that  she  will  not  have  the  exertion  of 
holding  it. 

If  artificial  light  is  necessary  it  should  be  on  a 
level  with  the  top  of  the  head  or  slightly  higher  and 
should  shine  over  the  left  shoulder. 

The  patient  should  positively  not  be  allowed  to 
read  or  work  after  she  becomes  tired  and  drowsy, 
for  in  these  conditions  there  is  a  natural  tendency 
for  the  muscles  of  the  eye  to  relax  and  prevention 
of  this  by  mental  effort  induces  very  harmful  strain 
upon  the  muscles. 

1 A  good  substitute  for  a  reading-table  when  a  person  is  in 
bed  is  a  wooden  box,  the  required  height,  with  enough  of  both 
sides  removed  to  allow  of  placing  the  box  across  the  patient's 
thighs.  The  required  tilt  can  be  obtained  by  placing  magazines 
under  the  far  edge  of  the  book  and  the  latter  can  be  kept  open  by 
driving  a  couple  of  nails  into  the  edge  of  the  box  where  the  free 
ends  will  hold  the  pages. 
6 


82  Nursing  Methods 

Demonstration  6 

Methods  of  Making  a  Patient  Comfortable  in 
Different  Positions 

Articles  required :  i .  A  bed  made  in  the  usual 
manner. 

2.  An  air-ring  or  a  substitute.    A  commonly 
used  substitute  consists  of  a  pad  made  of  several 
thicknesses  of  wadding  or  cotton  waste  stitched 
between  two  pieces  of  soft,  old  muslin,  with  a  hole 
in  the  center  slightly  larger  than  the  part  which  is 
threatened  with  a  bedsore. 

3.  Four  pillows  in   addition   to  the   two  on 
the  bed.     Two  of  the  pillows  should  be   small 
ones. 

4.  A  back-rest  and  a  chair  with  a  wide  flat  back 
to  use  as  a  substitute. 

5.  A  shoulder  wrap. 

6.  About  four  yards  of  heavy,  preferably  white, 
twine. 

7.  A  knee  support,  see  page  76. 

8.  A  wooden  box  about  one  foot  high  and  two 
feet  long. 

9.  A  bed-cradle  and  a  box  with  its  two  ends 
removed  to  act  as  a  substitute. 

It  is  well  for  the  pupils  to  alternate  being  subject 
for  this  demonstration. 

Procedure:  Make  the  patient  comfortable,  (i) 
lying  on  her  back ;  (2)  turned  on  her  side ;  (3)  lying 
prone;  (4)  sitting  up  in  bed.  Put  the  air-ring 


Essentials  for  a  Patient's  Comfort  83 

properly  inflated1  or  a  substitute  under  the  spine 
when  the  patient  is  on  her  back  and  under  her  hip 
when  she  is  lying  on  her  side.  In  each  of  the  posi- 
tions in  which  the  patient  is  lying  down  place  the 
bed-cradle  or  substitute  over  some  part  of  the  body 
and  arrange  the  covers  over  it  in  such  a  manner 
that  they  have  a  neat  appearance.  After  placing 
the  patient  in  the  sitting  position  take  measures, 
such  as  described  on  page  76,  to  prevent  her 
slipping  down  in  bed. 

Procedure:  Arrange  the  articles  that  you  will 
need  for  the  position  in  which  you  are  to  place  the 
patient  where  you  can  reach  them  and  in  the  order 
in  which  you  will  require  them. 

For  the  prone  and  lateral  positions  turn  the 
patient  on  her  side  as  directed  on  page  41 ,  put  the 
pillows  in  place,  and  then  turn  the  patient  on  or 
against  them  as  the  desired  position  requires. 

To  sit  a  patient  up  in  bed,  when  there  is  no  ad- 
justment as  shown  in  Fig.  13  on  the  bed,2  raise 
patient  by  passing  your  arm  that  is  nearest  the 
head  of  the  bed  behind  her  as  described  on  page  43 ; 
have  the  patient  place  her  hands  palms  downward 

1  Small  bulbs  can  be  bought  for  inflating  such  rings,  but  it  can 
be  done  equally  well  by  blowing  into  the  valve  on  the  side  of  the 
ring.    Put  a  piece  of  muslin  around  the  valve  before  putting  it 
into  the  mouth  and  be  sure  and  close  the  valve  before  removing  it 
from  the  mouth.  Just  enough  air  is  to  be  put  into  the  ring  to  keep 
the  affected  part  off  the  bed;  if  the  ring  is  made  too  taut  it  will 
cause  as  much  pressure  as  the  mattress. 

2  Such  a  rest  is  raised,  and,  with  it,  the  patient,  by  turning  a 
lever  provided  for  the  purpose. 


84  Nursing  Methods 

on  the  bed  and,  by  pressing  upon  them,  help  to  lift 
herself  as  you  raise  her  into  a  sitting  position.  If 
she  needs  to  be  supported,  put  your  other  arm 
across  her  chest  and,  if  necessary,  let  her  head  rest 
on  your  shoulder.  Put  the  wrap  around  her  shoul- 
ders and  make  sure  that  it  will  remain  in  place. 
Arrange  the  back-rest  and  pillows  as  described  and 
then  take  means  to  prevent  the  patient  slipping 
down  in  bed. 

Demonstration  7 

Preparing  a  Patient  to  Get  out  of  Bed  and  Making 
her  Comfortable  in  a  Chair.  Putting  her 
Back  to  Bed 

Important  points  to  be  considered:  When  we 
are  well  and  our  minds  are  occupied  we  are  not 
usually  conscious  of  the  pressure  of  our  clothes 
unless  they  are  uncomfortably  tight,  but,  when  a 
person  is  ill,  the  nerve  stimulation  caused  by  the 
pressure  of  corsets  and  skirt  bands,  even  though 
they  are  not  actually  tight,  may  give  rise  to  a  sense 
of  discomfort.  For  this  reason,  as  well  as  to  avoid 
tiring  the  patient  by  unnecessary  preparation,  she 
is,  as  a  rule,  clothed  only  in  a  nightgown,  wrapper, 
stockings,  and  slippers  when  she  gets  out  of  bed,  if 
she  is  not  well  enough  to  walk  around.  She  should 
be  provided  with  round  garters  but  they  must  only 
be  tight  enough  to  prevent  her  stockings  slipping 
when  she  steps  from  the  bed  to  the  chair. 


Essentials  for  a  Patient's  Comfort  85 

As  the  patient's  clothing  is  very  scanty,  wraps  of 
some  kind  must  usually  be  provided.  The  most 
appropriate  nature  and  arrangement  of  these  will 
depend  upon  the  temperature  of  the  room,  but 
unless  the  weather  is  very  warm  there  should  be 
one  to  put  around  the  shoulders  and  another  to 
wrap  about  the  legs  and  feet.  The  latter  cover  can 
be  laid  across  the  patient  and  hang  loose  if  the 
place  is  warm,  but  if  it  is  cold,  especially  if  the 
patient  is  to  sit  out  of  doors,  it  is  well  to  place 
the  center  of  this  wrap1  under  a  pillow  in  the  seat 
of  the  chair  and  the  lower  part  of  a  pillow  placed 
against  the  back  of  the  chair,  it  must  extend  far 
enough  beyond  the  lower  end  of  the  pillow  in  the 
seat  to  be  turned  up  over  the  patient's  feet  to  her 
knees  and  to  be  wrapped  about  her  legs  and  tucked 
under  the  pillows.  If  the  patient  sits  in  an  up- 
holstered chair  and  pillows  are  not  used,  the  wrap 
is  placed  in  the  chair  and  wrapped  about  the 
patient  as  just  described,  it  should  extend  well 
above  the  waistline.  The  other  wrap  is  pinned 
around  the  patient's  shoulders.  If  the  weather  is 
cold  and  the  patient  is  out  of  doors,  a  soft  cap  or 
hood  will  also  be  needed  and  it  is  well  to  place  a  hot- 
water  bottle  at  her  feet. 

A  comfortable  chair  must  be  provided.  A  good 
variety  is  that  known  as  a  steamer  chair  as  it  has  a 
foot-rest.  If  the  chair  used  has  no  such  attach- 
ment, a  footstool  will  be  needed.  If  the  chair  is 

1 A  colored  blanket  or  a  steamer  rug  will,  probably,  be  the  most 
suitable  kind. 


86  Nursing  Methods 

not  upholstered,  a  pillow  should  be  put  in  the  seat 
and  another  against  the  back  and,  if  possible,  a 
small  one  over  the  top  in  position  to  form  a  support 
for  the  head ;  a  pillow  for  this  purpose  will  probably 
be  needed  even  with  an  upholstered  chair. 

Placing  the  chair  is  another  important  point  to 
consider  when  a  weak  patient  is  to  sit  up  out  of  bed, 
and,  naturally,  the  first  point  to  be  considered, 
unless  there  is  someone  present  who  is  strong 
enough  to  carry  the  patient,  is  to  have  the  chair 
where  she  can  reach  it  without  unnecessary  walk- 
ing. There  may,  of  course,  be  other  points  to  be 
considered  such  as  having  the  chair  near  a  win- 
dow, or  out  of  a  draft.  The  means  of  making  any 
such  requirement  comply  with  the  first-mentioned 
requisite  should  be  decided  before  arranging 
the  pillows  and  wraps  in  the  chair,  unless  the 
latter  can  be  easily  moved  after  the  patient  is 
in  it. 

To  arrange  the  chair  so  that  little  walking  will 
be  required  place  it  either  parallel  with  the  bed, 
facing  the  head ;  or  else  at  right  angles  with  the  bed 
facing  it,  if  it  is  near  the  head,  but  with  its  back 
against  it,  if  near  the  foot. 

Articles  required : 

1.  Bed  made  in  the  usual  manner  and  with  a 
patient  (preferably  a  pupil)  in  it. 

2.  Wrapper.    It  is  well  to  provide  and  use,  in 
turn,  both  a  closed  wrapper  and  a  kimono. 

3.  Stockings  and  round  garters. 

4.  Chair,  for  demonstration  it  is  better  to  use 


Essentials  for  a  Patient's  Comfort  87 

a  chair  that  requires  to  be  made  comfortable  with 
pillows. 

5.  Footstool,  unless  there  is  a  foot-piece  to  the 
chair. 

6.  Pillows,  two  large  and  one  small. 

7.  Two  wraps  and  a  safety  pin. 
Procedure : 

1.  Arrange  the  chair,  i.e.,  put  it  in  position,  put 
a  wrap  in  the  seat  and  against  the  lower  part  of  the 
back,  as  described  on  page  85, 1  put  a  pillow  in  the 
seat  and  one  against  the  back,  but  do  not  put  the 
small  one  for  the  head  in  place  until  the  patient  is 
in  the  chair. 

2.  Put  on  the  patient's  wrapper.    If  this  is  a 
closed  one  put  it  on  in  the  same  manner  as  a  closed 
nightgown ;  if  it  is  a  kimono  pattern  and  the  patient 
is  well  enough  let  her  sit  up  in  bed  and  hold  the 
wrapper  while  she  slips  her  arms  into  the  sleeves, 
do  not  draw  down  its  skirt  until  the  patient  gets 
out  of  bed.    If  the  patient  is  not  well  enough  to 
sit  up,  spread  the  kimono  out  on  the  side  of  the 
bed,  under  the  top  covers,  draw  the  patient  over 
until  she  lies  on  its  back  width  and  put  her  arms2 
into  the  sleeves,  fasten  it  in  front. 

3.  Draw  the  patient  to  the  edge  of  the  bed. 

4.  Put  on  her  stockings:  to  do  this,  turn  the 
part  of  the  stocking  foot  below  the  heel  into  the 

1  It  is  better,  in  demonstration,  to  arrange  the  wraps  for  cold 
weather  because  there  is  no  special  point  in  their  disposal  when  it 
is  warm. 

3  If  time  permits  both  methods  of  putting  on  a  kimono  and  also 
a  closed  wrapper  should  be  demonstrated. 


88  Nursing  Methods 

leg  of  the  stocking,  slip  the  stocking  foot  over  the 
patient's  foot  and  pull  up  its  leg.  Put  on  round 
garters. 

5.  Turn  the  bedcovers  down  to  the  foot  of  the 
bed  so  that  they  will  be  out  of  the  way. 

6.  Get  the  patient  out  of  bed  and  place  her  in 
the  chair.    To  do  this,  if  she  is  well  enough  to  take 
a  few  steps,  but  needs  help:   Raise  her  and  turn 
her  so  that  her  legs  will  be  over  the  side  of  the  bed. 
Have  her  put  a  hand  on  your  far  shoulder,  put  your 
arm  around  her  waist  and  support  her  as  she  walks 
to  the  chair. 

If  the  patient  is  not  well  enough  for  this  exertion, 
get  an  assistant,  stand  one  on  either  side  of  the 
patient,  let  one  lifter  put  one  of  her  arms  around 
the  patient's  waist  and  one  under  her  knees  while 
the  other  puts  one  arm  across  her  shoulders  and 
the  other  under  her  thighs.  Have  the  patient  put 
an  arm  across  each  lifter's  back  and  place  her 
hands  firmly  on  their  far  shoulders.  The  lifters 
should  stand  on  opposite  sides  of  the  chair  while 
putting  the  patient  into  it. 

7.  Arrange  the  wraps  as  already  described. 
To  put  the  patient  back  to  bed,  if  she  can  help 

herself,  put  your  arm  around  her  waist  and  have 
her  put  her  hand  on  your  far  shoulder,  as  when 
you  were  helping  her  out  of  bed.  If  the  bed  is  a 
high  one,  have  the  patient  stand  with  her  back  to 
it  and  place  her  hands  upon  it ;  put  one  arm  around 
her  waist  and  one  under  her  knees ;  tell  her  to  raise 
herself  slightly  by  pressing  her  hands  upon  the  bed 


Essentials  for  a  Patient's  Comfort  89 

and,  as  she  does  so,  raise  her  on  to  the  side  of  the 
bed  and  then  turn  her  into  position. 

If  the  patient  needs  to  be  lifted  into  bed  get  an 
assistant  and,  standing  one  on  either  side  of  the 
chair,  take  hold  of  her  as  when  lifting  her  out  of 
bed.  It  is  more  difficult  to  raise  the  patient  from 
the  chair  than  from  the  bed,  and  thus,  if  the  pa- 
tient is  at  all  heavy,  at  least  one  of  the  lifters  must 
be  quite  strong.  Have  the  patient  place  her  hands 
very  firmly  upon  your  shoulders;  straighten  your 
backs  and  take  the  other  precautions  mentioned  on 
page  40  before  attempting  to  raise  her. 

After  the  patient  is  in  bed,  draw  up  the  covers; 
remove  the  wrapper  in  the  same  manner  as  you 
would  a  nightgown  of  similar  cut,  see  page  55, 
take  off  the  stockings  by  slipping  your  hand 
through  the  opening  and  drawing  them  down. 


CHAPTER  VI 
Baths.     Care  of  the  Hair 

Purposes  of  baths.  Effects  of  cold,  hot,  and  tepid  baths  and 
how  they  produce  these  effects.  What  is  meant  by  muscle  tone. 
Reasons  for  the  necessity  of  cleansing  baths.  Demonstration  8: 
Giving  a  cleansing  bath  to  a  person  in  bed.  Care  of  the  hair. 
Demonstration  9 :  Cleaning  the  hair.  Demonstration  10 : 
Washing  the  hair.  Demonstration  n:  Methods  of  giving  foot 
baths. 

The  equipment  for  Demonstration  8,  is  listed  on 
page  99;  that  for  Demonstration  9,  on  page  107; 
that  for  Demonstration  10,  on  page  108;  that  for 
Demonstration  1 1 ,  on  page  1 1 1 . 

The  Uses  and  Effects  of  Baths 

The  purposes  for  which  baths  are  most  com- 
monly used  in  the  treatment  of  the  sick  are:  To 

cleanse  the  body ;  to  stimulate  the  nervous  system ; 
to  lessen  nervous  irritability ;  to  improve  the  circu- 
lation of  the  blood ;  to  lessen  congestion ;  to  reduce 
excessive  muscular  contraction  such  as  occurs  in 
convulsions;  to  cause  sweating  and  thus  rid  the 
body  of  excess  water  and  waste  matter. 

Baths,  with  the  exception  of  those  used  solely 
for  cleansing,  gain  their  results  by  the  influence  of 

90 


Baths  91 

cold  and  heat  upon  the  body  and,  though  in  this 
lesson  only  cleansing  and  foot  baths  will  be  dem- 
onstrated, it  is  well  for  you  to  know  something 
of  the  effects  of  different  external  temperatures 
upon  the  body.  To  understand  these,  you  must 
know  that,  just  under  the  skin  and  in  the  muscles, 
there  are  millions  of  nerve  endings  which  are  the 
termination  of  what  are  known  as  afferent1  nerve 
fibers2  that  extend  to  what  are  termed  nerve  centers* 
in  the  spinal  cord  and  brain,  where  they  connect 
with  other  neurones  (efferent) 4  which  extend  out- 
ward to  the  muscles,  and  to  blood-vessels,  and  to 
glands,  and  other  internal  organs.  Some  of  the 
afferent  nerve  endings  in  the  skin  are  stimulated 
by  heat,  others  by  cold,  others  by  pressure ;  endings 
of  afferent  nerves  in  the  muscles  are  stimulated  by 
the  moving  of  the  muscles  and  by  chemical  sub- 
stances formed  in  the  tissues  as  the  result  of  their 

1  From  the  Latin  ad  =  to,  and  ferro  =  to  carry  =  to  carry  to. 

2  Groups  of  cell  bodies  and  their  uncovered  processes  form  what 
is  known  as  the  gray  matter  of  tJte  brain  and  cord.     Some  of  the 
processes  are  short  and  branching  and  are  known  as  dendrites, 
others  are  straight  and  long,  these  are  called  axons.    Many  of  the 
axons  extend  out  beyond  the  brain  and  cord  to  all  parts  of  the 
body  and  those  which  do  so  are  covered  with  a  sheath.  The 
covered  axons  are  known  as  nerve  fibers.     A  bundle  of  nerve 
fibers  is  called  a  nerve.    A  cell  body  and  its  processes  is  called  a 
neurone  or  a  nerve  cell.    The  cell  body  is  sometimes  likened  to  the 
chemical  battery  and  the  fibers  to  the  wires  of  an  electrical 
apparatus. 

s  Masses  of  gray  matter  that  are  the  origin  of  fibers  over  which 
impulses  pass  to  and  from  an  organ  and  help  to  control  its  func- 
tioning are  termed  nerve  centers. 

4  From  the  Latin  ef  =  out  and  ferro  =  to  carry  =  to  carry  out. 


92  Nursing  Methods 

activity;  the  optic  nerve  endings  in  the  eyes  are 
stimulated  by  light,  those  in  the  ears  by  the  vibra- 
tions that  we  call  sound,  those  in  the  nose  by  cer- 
tain volatile  substances,  those  in  the  tongue  by 
compounds  that  are  bitter,  sour,  salty,  or  sweet. 
When  the  nerve  endings  in  the  head  are  stimulated 
impulses1  pass  to  the  brain;  when  those  in  other 
parts  of  the  body  are  stimulated  impulses  pass  to 
the  spinal  cord  and,  sometimes,  up  the  cord  to  the 
brain.  In  the  cord  and  brain  the  impulses  pass 
over  to  the  efferent  fibers  and  along  these  to  the 
blood-vessels,  muscles,  etc.,  and  these  impulses 
make  muscle  tissue  contract  or,  if  they  pass  to 
glandular  organs,  they  make  the  cells  of  the  glands 
secrete ;  an  example  of  this  is  the  flow  of  saliva  that 
is  induced  when  the  nerve  endings  in  the  nose 
(olfactory  or  sense  of  smell)  and  in  the  tongue  are 
stimulated  by  the  pleasant  aroma  and  flavor  of 
food.  Constantly,  day  and  night,  but,  of  course, 
to  a  much  greater  extent  in  the  daytime  when  the 
muscles  are  active,  there  are  impulses  passing  from 
the  periphery  (outer  part)  of  the  body  to  the  brain 
and  cord  and  efferent  impulses  (aroused  by  the 
afferent  ones)  are  as  constantly  coming  out.  These 
impulses  help  to  maintain  the  muscles  in  a  condi- 
tion of  slight  contraction  that  is  known  as  tone. 
This  tone  is  very  important  for  the  well-being  of 

1  The  nature  of  nerve  impulses,  the  changes  they  induce  in 
nerve  centers,  and  the  reason  for  their  results  are  unknown,  but, 
it  is  believed,  every  impulse  leaves  some  trace  and  it  is  such  traces 
that  constitute  our  memories  and  the  basis  for  habits. 


Baths  93 

the  body,  for  examples :  (i)  Tone  is  necessary  for 

the  prompt  and  smooth  action  of  the  skeletal 
muscles  (the  muscles  covering  the  skeleton  and 
moving  the  bones) ;  (2)  it  is  essential  for  the  circula- 
tion of  the  blood  for,  if  the  tone  of  the  muscle  tissue 
in  the  blood-vessels  is  diminished,  the  vessels  re- 
lax and  cannot  then  force  the  blood  through  the 
body  properly,  in  fact,  if  their  tone  is  greatly  de- 
creased, death  will  result;  (3)  tone  is  necessary  for 
the  normal  action  of  internal  organs  that  contain 
muscle  tissue,  as  the  heart,  stomach,  intestine, 
and  bladder.  One  very  bad  result  of  imperfect 
action  of  the  stomach  and  intestines  is  that  food 
remains  in  these  organs  too  long  and  there,  es- 
pecially in  the  intestines,  undergoes  chemical 
changes  which  produce  substances  that  are  very 
injurious  to  the  body.  It  is  usually  such  sub- 
stances that  are  chiefly  responsible  for  the  head- 
ache, sleepiness,  and  other  indispositions  that  are 
associated  with  constipation. 

Lack  of  muscle  tone  is  common  whenever  ill 
health  exists  and,  ordinarily,  exercise  and  cold 
baths  tend  to  increase  it  and  warm  and  hot  baths 
to  reduce  it.  It  is  chiefly  because  of  the  influence 
of  baths  upon  this  very  important  body  phe- 
nomena— muscle  tone — that  this  digression  from 
the  main  subject  of  the  chapter  has  been  made. 

Action  of  cold  baths :  Cold  stimulates  the  end- 
ings of  nerve  fibers  in  the  skin  that  are  known  as 
cold-spots  and  impulses  then  go  over  the  fibers  to 
centers  in  the  cord  and  brain  in  which  the  impulses 


94  Nursing  Methods 

are  transmitted  to  the  muscles  and  to  the  muscle 
tissue  of  the  superficial  blood-vessels.  These  im- 
pulses cause  muscular  contraction  and  drive  much 
of  the  blood  from  the  surface  of  the  body  to  the 
deeper  muscles  and  internal  organs  and  this  in- 
creases the  chemical  reactions  that  yield  heat  and 
energy  to  the  body.  When  a  healthy  person  leaves 
the  bath,  or,  even  while  in  it,  if  exercise  is  taken,  as 
when  swimming,  the  increased  heat  produced  in 
the  system  induces  certain  reaction1  effects  and 
blood  is  forced  to  the  skin  which  then  becomes 
warm  and  red,  and,  because  there  is  more  blood  in 
the  skin,  there  is  more  heat  lost  from  the  body2 
and  a  rise  of  temperature  from  the  increased  heat 
production  is  prevented,  in  fact,  if  the  person 
has  fever,  her  temperature  may  be  considerably 
lowered  by  a  cold  bath. 

A  cold  bath  will  also  stimulate  the  portions  of 
the  brain  that  control  thought — how  many  of  you 
have  splashed  cold  water  on  your  face  when  you 
have  wanted  to  study  after  you  have  become 
sleepy?  As  cold  stimulates  the  brain,  cold  baths 
should  not  be  taken  at  bed  time  by  a  person  who 
does  not  go  to  sleep  easily. 

Because  cold  has  these  effects  the  practice  of 

1  By-  reaction  is  meant  action  in  a  contrary  direction  to  that  in 
which  advance  has  already  been  made.  The  physiological  processes 
involved  in  the  reaction  to  cold  are  only  imperfectly  understood 
and  space  will  not  permit  of  giving  the  theories;  pupils  interested, 
however,  will  find  them  under  Heat  Regulation  in  almost  any 
book  of  physiology. 

a  This  will  be  further  discussed  in  Chapter  VII. 


Baths  95 

taking  a  cold  bath  daily  tends  to  render  a  person 
sturdy  and  vigorous  for,  to  summarize,  a  cold  bath 
acts  as  a  nerve  stimulant,  it  improves  muscle  tone 
and  the  circulation  of  the  blood  and,  by  these 
actions,  it  increases  the  chemical  reactions  upon 
which  the  body's  nutrition  depends  and  facilitates 
the  removal  of  waste  matter  from  the  body  through 
the  bowels,  kidneys,  and  lungs.  Also,  a  daily  cold 
bath  lessens  a  tendency  to  "taking  cold"  easily 
because  (i)  congestion  of  the  throat  and  surround- 
ing parts  is  likely  to  result  from  chilling  of  the 
body  when  reaction  does  not  follow  and  the  results 
of  this  condition  favor  the  development  of  the 
bacteria  that  cause  colds ;  (2)  reaction  to  cold  does 
not  occur  readily  until  the  body  is  trained  to  re- 
spond to  this  stimulus  (cold)  in  the  right  way.  For 
all  activities  of  the  body  that  involve  coordination 
of  a  number  of  organs  are  only  carried  out  per- 
fectly after  some  kind  of  pathway  (the  nature  of 
which  is  unknown)  is  formed  through  nerve  cen- 
ters, and  such  a  pathway,  whether  it  is  for  abso- 
lutely involuntary  activity  (as  the  response  to 
cold)  or  for  voluntary  acts  (e.g.,  learning  to  swim), 
is  made  only  by  repetition.  Therefore,  the  person 
who  is  not  accustomed  to  cold  baths  is  likely  to 
shiver  for  quite  a  time  after  such  a  bath  or  when 
exposed  to  cold  air,  and  will  not  have  the  pleasant 
sensation  of  glow,  warmth,  exhilaration,  and  mental 
stimulation  that  cold  gives  a  person  in  whose 
nerve  centers  the  proper  pathways  have  been 
formed. 


96  Nursing  Methods 

There  is,  however,  a  certain  amount  of  danger 
in  the  use  of  cold  baths  when  people  are  ill,  because 
ill  health  often  prevents  reaction,  and  thus  cold 
baths  should  only  be  given  to  the  sick  by  those 
who  have  been  trained  to  observe  and  understand 
symptoms. 

Action  of  hot  baths :  A  hot  bath  (i.e.,  one  with  a 
temperature  that  is  more  than  a  few  degrees 
higher  than  the  normal  temperature  of  the  body, 
usually  between  103°  and  112°  F.)  will  cause  (i) 
free  perspiration;  (2)  muscular  relaxation;  (3) 
dilation  of  blood-vessels;  especially  those  of  the 
skin,  and,  consequently,  the  flow  of  an  extra 
amount  of  blood  to  the  surface  of  the  body,  and 
(4)  as  a  result  of  the  increased  amount  of  blood  at 
the  surface,  lessening  of  congestion  if  this  condi- 
tion exists.  Congestion  in  internal  organs  can  be 
relieved  even  by  hot  baths  that  involve  but  a  small 
portion  of  the  body  such  as  the  feet,  and  for  this 
reason  hot  foot  baths  are  often  given  to  relieve 
congestion  of  the  throat,  lungs,  or  other  internal 
organs. 

The  effects  produced  by  hot  baths  are  of  value 
in  many  diseases  but,  even  more  readily  than  cold 
baths,  they  may  also  have  very  bad  effects  and,  for 
this  reason,  they  should  only  be  given  to  a  sick 
person  by  someone  who  understands  the  symptoms 
that  may  arise. 

The  chief  uses  of  hot  baths  by  healthy  people 
are:  (i)  For  cleansing;  (2)  to  lessen  congestion  in 
the  uterus  during  menstruation,  or  that  following 


Baths  97 

chilling  of  the  body.  In  the  latter  case  a  hot  bath 
may,  by  relieving  conditions  favorable  to  the 
action  of  bacteria,  prevent  a  cold.  An  important 
point  to  remember  after  taking  a  hot  bath  for  such 
purposes  is  that  it  is  necessary  to  keep  warm, 
because  exposure  to  cold  air,  by  promoting  rapid 
evaporation  of  the  sweat,  may  chill  the  body  and 
increase  the  internal  congestion. 

Hot  baths  should  not  be  taken  frequently  except 
when  they  are  necessary  for  therapeutic  purposes 
for  they  cause  exactly  the  opposite  effects  of  cold 
baths  and  these,  it  can  be  realized  from  what  has 
been  said,  are  not  conducive  to  health.  When  they 
are  taken  for  cleansing  they  should  be  followed  by 
a  cold  plunge  or  spray. 

Action  of  warm  baths:  A  warm  bath  (i.e.,  one 
with  a  temperature  about  99°  F.)  is  ordinarily  the 
best  for  a  cleansing  bath  and  also  to  lessen  fatigue, 
either  muscular  or  mental.  For  the  latter  purpose 
it  is  customary  to  remain  lying  quietly  in  the  bath 
for  some  time,  about  thirty  minutes.  The  reason 
for  this  is  that,  if  the  bathroom  is  quiet  and  dark, 
and  the  water  about  the  same  temperature  as  the 
skin,  the  stimulation  of  superficial  nerve  endings 
will  be  lessened  and  consequently  the  amount  of 
impulses  passing  into  nerve  centers  much  de- 
creased and  thus  the  latter  have  a  chance  to  re- 
cuperate. As  fewer  nerve  impulses  pass  into  the 
centers,  fewer  come  out  and  the  muscles  become 
relaxed. 

Taking  baths  of  this  kind  before  going  to  bed  is 


98  Nursing  Methods 

often  advisable  while  one  is  subjected  to  unusual 
mental  strain  of  any  kind,  but  a  cold  bath  should 
be  taken  in  the  morning  to  counteract  the  effects  of 
the  warm  one  upon  muscle  tone. 

Cleansing  Baths 

Baths  are  necessary,  even  when  a  person  re- 
mains in  bed  all  day  and  does  not  look  dirty, 
because  (i)  the  perspiration  and  sebaceous  matter1 
discharged  upon  the  surface  of  the  skin  from  glands 
in  its  deeper  layer  contain  organic  substances  that, 
if  allowed  to  remain,  decompose  and  give  rise  to  an 
unpleasant  odor  and  are  conducive  to  irritation  of 
the  skin  and  chafing;  (2)  bathing  stimulates  the 
circulation  of  blood  in  the  skin  and  thus  aids  in  the 
various  functions  of  the  latter  and  lessens  any 
existing  tendency  to  the  formation  of  pressure 
sores;  (3)  a  bath  is  refreshing  to  the  majority  of 
people  who  must  remain  in  bed. 

If  possible  a  patient  should  be  bathed  daily, 
preferably  about  an  hour  after  breakfast  or 
shortly  before  she  is  ready  to  go  to  sleep  at  night. 
A  bath  should  not  be  given  within  about  an  hour 
after  a  meal,  because,  if  given  properly,  it  will,  for 
reasons  that  have  been  already  mentioned,  cause 
an  influx  of  extra  blood  to  the  skin  and  thereby 

1  The  sebaceous  matter  or  sebum  consists  chiefly  of  oily  sub- 
stances which  serve:  (i)  To  keep  the  skin  soft  and  pliable;  (2) 
to  prevent  the  too  rapid  evaporation  of  perspiration;  (3)  to  pro- 
tect the  skin  from  injury  by  excessive  humidity  or  dryness  of  the 
atmosphere. 


Baths  99 

lessen  the  amount  in  the  stomach  and  intestines 
at  a  time  when  it  is  needed  by  the  glands  in  these 
organs  for  the  manufacture  of  the  juices  required 
for  digestion. 

Demonstration  8 
Giving  a  Cleansing  Bath  to  a  Person  in  Bed 

Equipment:  The  doll  in  bed.  A  cotton  blanket. 
Something  to  protect  the  bed,  for  examples,  a 
large  bath  towel,  folded  sheet,  or  pad.  A  bath 
towel,  face  towel,  and  washcloth.  A  foot-tub  and  a 
basin  each  about  one  third  full  of  water,  the  water 
in  the  basin  should  be  about  110°  F.,  that  in  the 
tub  somewhat  warmer,  about  115°  F.,  to  allow  for 
cooling.  Manicure  utensils. 

Procedure:  I.  See  that  the  window  is  closed 
and  that  the  room  is  warm. 

2.  Collect  your  equipment  and  arrange  the 
articles  where  you  can  reach  them  easily  as  you 
require  them. 

3.  Put  two  chairs  near  the  foot  of  the  bed. 

4.  Replace  the  top  bedcovers  with  the  cotton 
blanket.    To  do  this,  if  the  bath  is  given  before  the 
bed  has  been  made,  remove  the  spread,  fold  it,  and 
place  it  where  it  will  not  get  crushed.    Fold  the 
blanket  in  four  and  place  it  across  the  patient's 
chest  with  its  ends  facing  her  head.    If  the  patient 
is  well  enough  she  can  generally  be  asked  to  hold 
the  lower  end,  if  she  is  not,  tuck  this  end  firmly 


ioo  Nursing  Methods 

under  her  shoulders  or  the  pillow.  Then  take  the 
upper  end  between  your  third  and  fourth  fingers, 
on  either  side  of,  and  a  little  beyond,  the  patient. 
Put  your  other  fingers  under  the  covers'  and  your 
thumb  on  top  and  draw  the  covers  down  over  the 
foot  of  the  bed  and  across  the  backs  of  the  chairs. 
As  the  blanket  is  between  your  fingers  it  is  drawn 
over  the  patient  at  the  same  time  as  the  covers  are 
removed,  loosen  your  hold  of  it  as  soon  as  it  covers 
the  feet.  Raise  the  foot  of  the  mattress  and  pull 
out  the  covers  and  separate  them  so  that  they  will 
air  while  the  bath  is  being  given. 

If  the  bed  has  been  made  it  will  not  be  necessary 
to  remove  the  spread  but,  so  that  it  will  not  be 
crushed,  it  is  well  to  fold  the  covers  neatly  down  to 
the  foot  of  the  bed.  A  method  that,  after  a  little 
practice,  allows  of  this  being  done  very  quickly 
and  deftly  is  as  follows:  Place  the  blanket,  and 
take  hold  of  it  and  the  covers,  as  described  in  the 
preceding  paragraph,  make  a  fold  in  the  covers 
about  twelve  to  fourteen  inches  deep,  then,  still 
holding  the  blanket,  and  with  your  thumb  on  top 
of  the  covers,  pass  your  free  fingers  under  the  upper 
edge  of  the  fold  and  make  a  second  fold.  Repeat 
the  procedure  until  the  clothes  are  as  far  down  as 
possible  to  have  them  without  loosening  them  at 
the  corners,  then,  either  leave  them  folded1  and, 
if  they  are  not  below  the  patient's  feet,  raise  the 

1  The  covers  are  usually  left  folded  if  the  bed  has  been  made 
recently  but,  otherwise,  it  is  well  to  draw  the  folds  out  over  a 
as  this  allows  the  sheet  to  air. 


Baths 


101 


latter  over  the  fold,  or  else  draw  out  the  folds,  and 
bring  as  much  of  the  covers  over  the  backs  of  the 


Fig.  24.     Replacing  bedcovers  with  blanket. 

chairs  as  possible  without  disturbing  them  at  the 
foot  and  corners  of  the  mattress. 

5.  Draw  the  patient  to  the  side  of  the  bed. 

6.  Remove  the  nightgown. 

7.  Proceed  with  the  bath,  washing  in  following 
order:  Face,  ears,  neck,  arms,  hands,  chest,  ab- 
domen, back,  thighs,  legs,  feet,  pubic  region.    Put 
the  protector  under  each  part  before  you  wash  it. 
While  working  remember  the  following  points : 

(a)  Make  firm  pressure. 

(b)  Expose  only  the  part  that  you  are  washing 
at  the  time,  and  even  this  much  exposure  is  not 
usually  necessary. 

(c)  After  washing  a  part,  dry  it  before  going 
farther. 


102  Nursing  Methods 

(d)  Wash  and  dry  the  ears,  between  the  fingers 
and  toes,  the  axilla,  and  pubic  region  particularly 
well. 

(e)  Use  the  water  in  the  basin  for  the  face,  neck, 
arms,  and  hands. 

(f)  Before  washing  a  hand  place  the  towel  and 
(on  this)  basin  under  it,  then  soak  the  washcloth 
with  water  and  squeeze  the  water  through  the 
fingers;  repeat  this  procedure  after  washing  the 
hand  with  soap  and  then  place  the  hand  on  the 
towel,  remove  the  basin,  and  dry  the  hand.    Treat 
the  other  hand  in  like  manner. 

(g)  If  the  knees  can  be  flexed  and  there  is  no 
reason  why  the  feet  cannot  remain  in  water  for  a 
few  minutes,  put  them  into  the  tub  before  begin- 
ning to  wash  the  thighs  and  legs.     To  do  this: 
Flex  the  patient's  knees,  put  the  tub  on  the  side  of 
the  bed  near  the  feet,  under  the  blanket;  place 
your  arm  that  is  nearest  the  foot  of  the  bed  across 
the  tub — see  Fig.  26 — this  prevents  the  blanket 
getting  into  the  water;  put  your  free  arm  under 
the  patient's  legs  and  your  hand  under  her  heels; 
raise   the   legs   and   feet;   draw   the   tub   under 
them  and  lower   them  into  the  water.      (This, 
like  the  rest  of  the  bath,  can  be  done  under  the 
blanket.) 

To  remove  the  feet:  Fold  the  bath  towel  and 
place  it  on  the  bed  at  the  far  side  of  the  tub ;  take 
hold  of  the  feet  and  tub  as  before;  raise  the  feet, 
hold  them  over  the  tub  for  a  few  seconds  until  the 
water  stops  dripping  from  them,  place  them  on  the 


Baths  103 

towel;  remove  the  blanket  from  above  the  tub; 
take  the  tub  from  the  bed ;  dry  the  legs  and  feet. 

(h)  Turn  the  patient  on  her  side  before  washing 
her  back. 

8.  Cut  and  clean  the  finger  and  toe  nails  if  neces- 
sary.   Have  a  towel  under  them  while  you  are 
doing  so. 

9.  Remove  the  upper  blanket.    To  do  so,  take 
hold  of  the  upper  edges  of  the  bedcovers,  draw 
them  up  to  the  foot  of  the  bed,  then  include  the 
lower  end  of  the  blanket  in  your  grasp  and  draw 
clothes  and  blanket  upward,  take  out  the  blanket. 

10.  Put  on  the  nightgown. 

1 1 .  Remove  all  your  equipment  and  put  chairs, 
etc.,  in  place. 

Important  points  to  remember  when  a  conval- 
escent patient  takes  a  tub  bath: 

1.  If  a  patient  has  been  very  ill  she  should  not 
be  allowed  to  take  a  tub  bath  before  convalescence 
is  well  advanced  without  the  doctor's  permission. 

2.  See  that  the  bathroom  is  warm  before  the 
patient  goes  to  it. 

3.  Be  sure  that  the  patient  has  everything  that 
she  needs  for  her  bath — bath  towel,  face  towel, 
washcloth,   nailbrush,    soap,    clean    clothing    if 
necessary. 

4.  Fill  the  tub  half -full  of  water  about  96°  F., 
usually  not  hotter.    Let  the  cold  water  run  into 
the  tub  at  the  same  time  as  the  hot.   Never  run  the 
hot  water  in  first,  especially  when  preparing  the 


104  Nursing  Methods 

bath  for  a  child,  for  this  has  been  the  cause  of  many 
accidents. 

5.  Do  not  allow  the  patient  to  lock  the  door  nor 
leave  her  long  alone  without  speaking  to   her  to 
ascerstain  that  she  is  all  right. 

6.  If,  for  any  reason  other  than  therapeutic 
purposes,  the  bath  water  is  above  96°  F.,  do  not 
let  the  patient  remain  in  it  longer  than  ten  minutes. 
For  reason  see  page  97. 

7.  As  soon  as  the  patient  leaves  the  bathroom, 
wash  the  tub  and  tidy  the  room. 

Care  of  the  Hair 

During  and  after  an  illness  of  any  severity  the 
hair  is  likely  to  fall  out  and  the  scalp  to  become 
covered  with  dandruff,  and  these  conditions  are 
favored  by  lack  of  care  of  the  hair  and  scalp. 

Dandruff  consists  of  dried  sebaceous  matter  or 
sebum  and  cells1  that  have  become  separated  from 
the  scalp.  The  sebum  is  a  fatty  substance  that  is 
secreted  by  small  glands  similar  to  those  in  the 

1  The  skin,  including  the  scalp,  consists  of  two  layers,  a  thin 
outer  layer  (known  as  the  epidermis  or  cuticle)  consisting  of  dry 
flattened  cells  that  have  been  pushed  forward  from  the  under 
layer  (the  derma)  where  the  production  of  new  cells  is  constantly 
taking  place.  The  outer  cells  of  the  epidermis  are  being  con- 
stantly rubbed  off,  but,  except  those  of  the  scalp,  they  are  so 
minute  that,  ordinarily,  they  are  not  visible.  Even  those  of  the 
scalp,  when  the  latter  is  in  a  healthy  condition  and  kept  clean,  are 
hardly  discernible.  The  discharge  of  these  cells,  however,  be- 
comes excessive  when  conditions  arise  that  interfere  with  the 
circulation  of  blood  in  the  derma. 


Care  of  the  Hair  105 

skin  of  other  parts  of  the  body.  The  glands  dis- 
charge their  secretion  into  what  is  known  as  the 
hair-follicles  (small  pockets  or  inversions  in  the 
derma1  in  which  the  roots  of  the  hair  are  situated) 
and  it  passes  out  along  the  shafts  of  the  hairs.1 
It  serves,  when  not  in  excess,  to  keep  the  hair  soft 
and  pliable,  but  excessive  secretion  and  the  pres- 
ence of  dandruff  are  nearly  always  associated 
with  falling  of  the  hair. 2  The  reasons  for  the  ex- 
cessive secretion  are  not  always  discoverable  and 
some  physicians  consider  that  some  as  yet  un- 
known microorganisms  may  be  sometimes  the 
active  cause.  But,  whatever  the  underlying  cause 
of  both  the  excessive  secretion  of  sebum  and 
shedding  of  cells  that  give  rise  to  dandruff  and  the 
falling  of  hair,  they  are  favored  by  inefficient  cir- 
culation of  the  blood  in  the  scalp .  Common  causes 
of  poor  circulation  are :  A  thin,  tight  scalp ;  nervous- 

1 A  hair  consists  of  a  small  bulbous  portion,  known  as  the 
root,  and  a  straight  extension,  called  the  shaft.  There  are  three 
layers  to  a  hair,  an  outer  one  consisting  of  flat  cells  that  overlap 
each  other  like  the  tiling  of  a  roof,  a  middle  portion  consisting 
chiefly  of  elongated  cells  and  of  pigment  to  which  the  color  of  the 
hair  is  due,  and  an  inner  layer  of  practically  spherical  cells.  The 
cells  of  the  shaft  grow  out  from  the  root  and  the  root  absorbs 
nourishment  from  the  lymph  that  comes  from  the  blood-vessels 
in  the  derma. 

The  hairs,  as  can  be  seen  from  the  above  description,  are  not 
tubes,  as  is  very  commonly  supposed,  and  thus  there  is  no  founda- 
tion for  the  very  prevalent  idea  that  the  ends  of  the  hair  should  be 
singed  after  being  cut  to  prevent  the  escape  of  oil  and  nutrient 
material. 

2  It  is  probably  the  conditions  producing  the  dandruff,  rather 
than  the  dandruff,  that  causes  the  hair  to  fall. 


io6  Nursing  Methods 

ness;  general  ill  health;  wearing  tightly  fitting 
hats.  Conditions  and  treatments  that  favor  free 
circulation  of  blood  in  the  scalp  and,  consequently 
the  nutrition  of  the  hair,  are :  A  thick,  loose  scalp, 
brushing  the  hair  thoroughly  at  least  once  daily; 
massaging  the  scalp  and  keeping  it  clean.  Some 
physicians  say  that  tonics  are  valueless  and  others 
that  certain  ones  are  of  use,  especially  those  con- 
taining substances  that  promote  a  mild,  temporary 
irritation  of  the  scalp  and  thus  increase  the  amount 
of  blood  around  the  roots  of  the  hairs  for,  when 
any  part  is  irritated,  more  blood  goes  to  it ;  this  can 
be  seen  by  the  redness  that  follows  rubbing  the 
skin.  Also,  tonics  are  of  value  because  their  use  is 
associated  with  massage,  and  the  alcohol  which 
they  nearly  all  contain  helps  to  clean  the  scalp. 
Care  of  the  hair  is  particularly  important  when  a 
person  is  ill,  but  is  very  commonly  neglected  for 
fear  of  tiring  the  patient.  As  a  matter  of  fact,  if 
the  hair  is  braided  properly  in  two  braids,  as  de- 
scribed on  page  62,  its  care  will  necessitate  very 
little,  if  any,  fatigue  for  the  patient.  The  care 
should  consist  in  a  daily,  thorough  brushing  and 
moving  the  scalp  by  placing  the  fingers  firmly 
upon  it  and,  keeping  them  in  one  place  for  a  few 
seconds,  while  moving  the  scalp  back  and  forth  in 
all  directions,  then  moving  them  to  another  part 
and  repeating  the  procedure  until  all  the  scalp  has 
been  treated.  If  the  hair  becomes  oily  it  should  be 
either  washed  or  given  what  is  sometimes  called  a 
dry  cleansing.  The  latter  is  far  less  tiring  than  a 


Care  of  the  Hair  107 

regular  shampoo.  Do  not  use  a  fine-toothed  comb 
to  remove  dandruff,  for  it  only  does  so  temporarily 
and  the  pointed  prongs  scratch  the  scalp  and  may 
cause  harmful  irritation. 


Demonstration  9 
Cleaning  the  Hair 

Articles   required:  i.    Orris   root,    about   one 
tablespoonful  tied  in  a  small  piece  of  gauze. 

2.  A  hair  lotion,1  about  ^  ounce  in  a  small 
glass. 

3.  A  medicine  dropper. 

4.  A  comb  and  a  brush  with  stiff  bristles. 

5.  A  little  absorbent  cotton. 

6.  Two  towels  and  a  safety  pin. 
Procedure:  I.     Put  one  towel  under  the  pa- 
tient's head  and  pin  the  other  around  her  neck. 

1 A  hair  lotion  commonly  used  in  hospitals  when  the  physician 
does  not  prescribe  a  special  tonic  is  as  follows: 

R  Sodium  bicarbonate  150  gm. 
Ext.  witch  hazel") 
Alcohol  95%       }•  a.a.  835  c.c. 
Water  J 

This  quantity  is,  of  course,  for  the  stock  solution;  only  about 
2  3  are  used  at  a  time,  being  poured  when  needed  into  a  small 
glass. 

If  there  is  dandruff  the  following  prescription  is  sometimes 
substituted: 

Resorcin  10  gm. 
Alcohol  95%  40  c.c. 
Water  50  c.c. 


io8  Nursing  Methods 

2.  Undo  one  braid. 

3.  Separate  a  strand  of  hair,  brush  it  well  and 
then  pat  it  on  both  sides,  and  also  the  scalp  around 
it,  with  the  sack  of  orris  root.     Place  this  strand 
where  it  will  not  get  mixed  with  the  remainder  of 
the  hair,  separate  another  strand  and  repeat  the 
procedure,  do  this  until  all  the  unbraided  hair  has 
been  so  treated.    Then  put  a  thin  layer  of  absorb- 
ent cotton  over  the  brush  and  press  it  in  with  the 
comb,  brush  a  strand  of  hair  with  this  (it  takes  up 
the  orris  root  and  with  it  oily  matter  that  was  on 
the  hair) ;  fill  the  medicine  dropper  with  lotion  and 
run  it  along  the  scalp  (squeezing  the  lotion  from  it 
at  the  same  time),  where  the  orris  has  been  re- 
moved.   Take  another  strand  of  hair  and  repeat 
the  procedure,  do  this  until  all  the  unbraided  hair 
has  been  treated.     Then   rebraid   this.     If  the 
patient  is  tired  leave  the  other  braid  until  later  or 
even  the  next  day;  if  she  is  not  too  tired,  turn  her 
head  and  repeat  the  procedure. 

Demonstration  10 
Washing  the  Hair  with  the  Patient  in  Bed 

Equipment:  i.  Two  small  rubbers,  pieces  of 
old  blanket,  paper,  or  bath  towels  may  be  sub- 
stituted. 

2 .  A  piece  of  rubber  about  a  yard  wide  and  long 
enough  to  cover  the  pillow  and  extend  into  a  basin 
or  foot-tub  placed  on  a  chair  at  the  side  of  the  bed. 


Care  of  the  Hair  109 

3.  Three  face  towels  and  one  bath  towel. 

4.  A  safety  pin. 

5.  A  quart  pitcher  of  hot  soap  solution  (about 
110°  F.),  any  good  soap  can  be  used,  but  the  liquid 
green  soap  used  in  surgery  for  cleaning  the  skin  is 
particularly  good,  it  can  be  bought  at  any  drug 
store.    Enough  soap  should  be  used  to  make  a  good 
lather. 

6.  A  large  pitcher  of  water  about  1 10°  F. 

7.  Something  to  protect  the  table  if  it  is  likely 
to  be  injured  by  the  hot  pitchers — a  towel  or  paper 
will  answer  the  purpose. 

Procedure : 

Arrange  the  equipment :  Put  a  protector  on  the 
table  under  the  pitchers,  place  the  foot-tub  on  a 
chair  or  stool  near  the  head  of  the  bed  at  the  side 
at  which  you  will  stand  while  washing  the  hair, 
hang  one  face  towel  where  you  can  reach  it  easily. 

Draw  the  patient  to  the  side  of  the  bed  and  turn 
her  on  her  side  with  her  back  toward  you. 

Loosen  her  nightgown  at  the  neck  and  turn  it 
down. 

Double  a  towel  over  one  edge  of  a  rubber,  put 
these  around  the  neck  and  pin  the  towel  in  such 
fashion  that  it  will  hold  the  rubber  in  place. 

Move  the  top  pillow  from  under,  but  just  in 
front  of,  the  patient's  head. 

Cover  a  small  rubber  with  the  bath  towel  and 
this  with  the  large  rubber  arranging  the  latter  so 
that  it  will  extend  about  twelve  inches  above, 
below,  and  in  front  of  the  patient's  head. 


i  io  Nursing  Methods 

Put  these  under  the  patient's  head  with  the  small 
rubber  undermost  and  covering  the  pillows ;  roll  up 
both  sides  of  the  large  rubber  so  that  it  forms  a 
trough  with  one  roll  under  the  patient's  neck,  have 
one  end  covering  the  near  portion  of  the  pillow 
which  was  moved,  and  which  serves  as  a  wall  for 
the  trough,  and  the  other  hanging  free  over  the 
side  of  the  bed. 

Put  one  corner  of  a  face  towel  between  the 
patient's  face  and  the  roll  of  rubber  and  leave  the 
rest  of  it  free  to  wipe  her  face  with,  if  necessary, 
during  the  shampoo. 

Undo  the  hair  and  spread  it  out  in  the  trough. 

Draw  the  chair  with  the  tub  into  position  and 
put  the  free  end  of  the  trough  rubber  into  this. 

Pour  the  soap  solution  slowly  over  the  head; 
turning  the  latter  as  required,  rub  the  soap  into 
the  scalp  and  through  the  hair  as  you  proceed  and, 
occasionally,  discontinue  pouring  while  you  rub 
the  scalp.  When  the  soap  solution  is  finished, 
pour  some  of  the  water  from  the  large  pitcher  into 
the  small  one — as  the  latter  is  more  easily  handled 
— and  pour  this  over  the  head,  rubbing  the  latter 
with  one  hand  as  you  do  so. 

When  the  soap  has  all  been  removed,  squeeze 
the  water  from  the  hair,  wipe  the  patient's  face, 
neck,  and  ears  with  the  towel  that  you  placed  under 
her  face,  moving  back  the  rubber  at  this  point 
when  you  take  away  the  towel ;  gather  the  hair  into 
the  towel,  remove  the  trough  rubber,  letting  it 
down  into  the  foot-tub. 


Foot  Baths  1 1 1 

The  patient's  head  is  then  on  the  bath  towel. 
Dry  the  hair  with  this  and  the  face  towel. 

When  the  hair  is  as  dry  as  you  can  get  it,  unpin 
the  towel  that  is  around  the  patient's  neck,  re- 
move this  and  the  rubber  and  use  the  former  to 
replace  the  bath  towel  unless  it  is  wet ;  in  such  case, 
use  the  towel  that  you  hung  at  the  top  of  the  bed. 

Fasten  the  nightgown,  place  your  patient  in  a 
comfortable  position,  spread  out  her  hair  to  dry. 
Fan  it. 

Put  everything  around  the  bed  in  order  and  re- 
move your  equipment. 

Foot  Baths 

As  previously  stated  a  foot  bath  is  very  fre- 
quently used  to  relieve  congestion.  It  does  so 
because,  by  dilating  the  blood-vessels  in  the  feet 
and  legs,  it  increases  the  amount  of  blood  in  these 
parts  and,  therefore,  of  course,  lessens  the  amount 
in  other  parts.  Mustard  is  sometimes  added  to 
the  water,  because,  by  its  irritant  action,  it  in- 
creases the  effects  of  the  heat. 

Demonstration  n 

Giving  a  Foot  Bath  to  a  Patient  (i)  in  Bed;  (2) 
Out  of  Bed 

Equipment:  i.    A  foot-tub  half  full  of  water, 
usually  110°  or  115°  F. 
2.    A  bath  blanket. 


ii2  Nursing  Methods 

3.  A  bath  towel. 

4.  A  face  towel. 

5.  A  covered  hot-water  bag. 

6.  A  bath  thermometer. 

7.  Mustard  dissolved  in  cold  water.     For  an 
adult,  one  tablespoonful  and,  for  a  child,  half  a 
tablespoonf ul  for  each  gallon  (four  quarts)  of  water. 

Procedure  when  the  patient  is  in  bed : 

Loosen  the  upper  bedcovers  at  the  foot  of  the 
bed. 

Double  the  bath  blanket  lengthwise  and  then 
fold  it  in  four  with  the  two  ends  one  on  each  side 
of  the  central  fold. 

Place  this  across  the  foot  of  the  bed,  under  the 
loosened  covers  with  the  ends  toward  the  foot. 
Stand  near  the  foot  of  the  bed,  take  the  upper  fold 
of  blanket  between  your  third  and  fourth  fingers 
and  the  bedcovers  between  your  other  fingers  and 
thumbs  and  turn  the  covers  back  to  above  the 
knees,  carrying  up  the  blanket  over  the  legs  at  the 
same  time. 

Add  the  dissolved  mustard  to  the  water  in  the 
bath.  The  reason  why  it  should  not  be  added 
sooner  will  be  found  on  page  183. 

Flex  the  patient's  knees. 

Turn  back  the  lower  portion  of  the  blanket  so 
that  it  will  cover  the  part  of  the  bed  on  which  the 
tub  is  to  rest. 

Place  the  tub  on  the  bed,  near  the  feet  over  the 
lower  fold  of  blanket. 


Foot  Baths 


113 


Put  your  arm  that  is  nearest  the  head  of  the  bed 
under  the  patient's  legs  and  your  hand  under  her 
heels. 

Put  your  other  arm  across  the  tub,  grasping  it 
on  the  far  side,  and  move  it  forward  into  position 
while,  at  the  same  time,  you  raise  the  patient's  feet 


Fig.  26.  Foot  bath.  The  blanket  has  been  drawn  up  to  shew 
the  manner  of  holding  the  feet  while  putting  them  into  the  tub, 
ordinarily  they  should  not  be  exposed. 


and  legs  from  the  bed.  This  is  done  under  the  top 
layer  of  blanket,  the  arm  being  kept  across  the 
tub  to  prevent  the  blanket  getting  into  the  water. 

Before  lowering  the  feet  into  the  water,  tell  the 
patient  that  it  is  hot,  but  that  it  cannot  possibly 
burn  her.  Put  the  feet  in  slowly  and,  if  the  patient 
objects  to  the  heat,  raise  and  lower  them  alter- 
nately for  a  short  time  until  she  becomes  accus- 
tomed to  it. 

Put  the  edge  of  a  folded  towel  between  the 


ii4  Nursing  Methods 

patient's  legs  and  the  rim  of  tub ;  be  sure  that  it  is 
not  near  the  water. 

Take  hold  of  the  upper  edge  of  the  blanket  and 
hold  it  in  position,  while  with  your  other  hand  you 
draw  down  the  covers. 

Roll  the  hot-water  bag  in  the  bath  towel 
(to  warm  the  latter)  and  place  it  under  the 
covers. 

The  feet  are  kept  in  the  water  for  from  twenty 
to  thirty  minutes.  If  it  is  necessary  to  raise  the 
temperature  of  the  water,  bring  some  water  that  is 
about  150°  F.,  in  a  pitcher,  and  pour  it  in  slowly, 
keeping  your  hand  between  the  patient's  legs  and 
the  stream.  This  can  be  done  without  uncovering 
the  tub  except  at  the  point  where  you  are  pouring 
in  the  water. 

To  remove  the  tub:  Turn  the  bedcovers  back 
above  the  knees,  but  leave  the  blanket  covering 
the  legs.  Take  the  bath  towel  from  the  hot-water 
bag  and  place  it  on  the  far  side  of  the  tub.  Take 
the  towel  from  behind  the  patient's  legs. 

Put  your  arm  under  the  legs  as  when  putting 
them  in  the  tub,  raise  them  from  the  water  and 
hold  them  over  the  tub  for  a  few  seconds,  that  the 
water  may  drain  from  them,  then  put  one  side  of 
the  layer  of  blanket  that  is  covering  them  around 
them  and  lower  the  feet  on  the  bath  towel. 

Remove  the  tub.  Dry  the  feet  and  then  remove 
the  blanket  from  underneath  them. 

Put  the  hot-water  bag  at  the  feet. 

Draw  down  the  covers  and,  with '  them,  the- 


Foot  Baths  115 


• 


blanket.    Remove  the  latter  and  tuck  the  covers 
under  the  mattress  as  usual. 
Procedure  when  the  patient  is  not  in  bed : 

Provide  a  comfortable  chair  and  over  the  outer 
edge  of  the  seat  and  the  floor  spread  a  heavy 
colored  blanket. 

Have  the  patient  sit  on  the  chair,  remove  her 
shoes  and  stockings  and  turn  her  skirts  up  above 
her  knees. 

Put  the  tub  in  position,  place  the  patient's  feet 
in  the  water  and  envelop  her  legs  and  the  tub  with 
the  blanket. 

Add  hot  water,  if  necessary,  in  the  same  manner 
as  when  the  bath  is  given  in  bed. 

After  about  twenty  minutes,  remove  the  bath 
and  dry  the  feet  thoroughly. 


CHAPTER  VII 
Temperature.    Pulse.  Respiration.    Records 

Heat  production,  elimination,  and  regulation.  Fever.  Nature 
and  care  of  thermometers.  Demonstration  12:  Procedure  in 
taking  the  temperature.  The  nature  of  the  pulse.  Conditions 
that  cause  changes  in  the  rate  and  character  of  the  pulse.  The 
nature  of  respiration  and  of  breathing.  Factors  controlling  these 
functions.  Demonstration  13:  Counting  the  pulse  and  breathing. 
Some  important  reasons  for  keeping  records  of  a  patient's  con- 
dition. Nature  of  records. 

The  equipment  for  Demonstration  12  is  listed  on 
page  125  and  that  for  Demonstration  13  on  page  136. 

Heat  Regulation 

Temperature  has  been  denned  as  the  degree  of 
hotness  of  a  body  measured  by  a  chosen  standard. 

In  referring  to  measurements  of  heat  two  ex- 
pressions are  used,  viz.,  amount  and  degree.  An 
example  of  the  difference  between  the  two  measure- 
ments is  as  follows:  The  temperature  of  eight 
ounces  of  boiling  water  is  the  same  as  that  of  two 
thousand  ounces  of  boiling  water,  but  there  is  a 
much  larger  amount  of  heat  in  the  vessel  holding 
the  two  thousand  ounces  than  in  that  containing 
the  eight  ounces.  The  degree  of  heat  is  ascertained 

116 


Temperature 

with  a  thermometer  and  recorded  in  degrees;  the 
amount  of  heat  is  ascertained  by  the  use  of  a  calori- 
meter and  recorded  in  calories.  Unfortunately, 
two  standards  are  used  and  expressed  in  terms  of 
calories.  In  Physics,  the  calory  is  said  to  be  the 
amount  of  heat  necessary  to  raise  the  temperature 
of  a  gram  of  water  one  degree  centigrade  and  in 
Physiology  and  Dietetics  a  Calory  is  considered 
as  the  amount  of  heat  required  to  raise  the  temperature 
of  a  kilogram  of  water  one  degree  centigrade.  The 
former  is  sometimes  termed  the  small  calory  and 
the  latter  the  large  calory  and  a  capital  C  is  com- 
monly used  when  the  large  Calory  is  referred  to. 

The  amount  of  heat  produced  in  the  human 
body  varies  considerably  under  different  circum- 
stances, but,  nevertheless,  there  is  very  little 
fluctuation  in  the  degree  of  heat  (commonly  desig- 
nated the  temperature)  of  a  healthy  individual. 
The  reason  for  this  is  that  the  body  is  provided 
with  a  mechanism  to  control  the  rate  of  heat  pro- 
duction and  elimination.  The  details  of  the  action 
of  this  mechanism  are  as  yet  but  imperfectly 
understood  but,  experiments  seem  to  show,  that 
there  are  small  masses  of  gray  matter  in  the  brain 
that  are  influenced  by  the  temperature  of  the  blood 
as  it  passes  through  them  and,  as  the  result  of  this 
influence,  send  impulses  to  nerve  centers  control- 
ling organs  that  influence  heat  production  and 
elimination.  The  portions  of  gray  matter  that 
are  affected  by  the  temperature  of  the  blood  are 
termed  heat  regulating  centers. 


ii8  Nursing  Methods 

Heat  is  produced  chiefly  in  the  muscles  as  the 
result  of  the  oxidation x  of  substances  derived  from 
food.  The  amount  of  material  oxidized  depends 
largely  upon  the  amount  of  muscular  contraction 
that  occurs  and  thus  oxidation  goes  on  more 
rapidly  and,  consequently,  more  heat  is  produced 
when  a  person  is  active,  than  when  at  rest,  and 
convulsions,  which  consist  of  intense  muscular 
contraction  may  cause  a  very  excessive  rise  of 
temperature.  The  underlying  reasons  for  the  in- 
crease of  oxidation  by  muscular  contractions  are 
unknown.  Very  important  requisites  for  the 
maintenance  of  oxidation  in  the  tissues  are  certain 
chemical  substances  manufactured  by  special 
glands  and  brought  to  the  tissues  by  the  blood. 
Thus,  it  may  be  said,  that  the  chief  requisites  for 
the  maintenance  of  body  heat  are  food,  oxygen,  and 
chemical  substances  that  promote  oxidation,  and 
the  rate  of  oxidation  is  chiefly  dependent  upon 
the  amount  of  muscular  contraction  that  occurs.2 
Other  less  important  sources  of  body  heat  are: 

1  The  union  of  oxygen  with  matter.  When  oxygen  unites  with  a 
compound  it  decomposes  it  into  simpler  substances  and  liberates 
the  energy  (power  to  do  work)  that  held  its  molecules  together. 
Some  of  this  energy  is  manifest  in  the  form  of  heat.  The  muscles, 
heart,  and  lungs  and  other  organs  of  the  body  are  just  as  depen- 
dent upon  the  energy  thus  liberated  for  their  power  to  do  work  as 
the  machinery  of  a  ship  is  upon  the  energy  liberated  from  the 
coal  burned  in  its  furnace.  When  oxidation  takes  place  rapidly 
enough  to  induce  fire  it  is  spoken  of  as  burning  or  combustion. 

1  Some  physiologists  consider  that  there  may  be  differences 
either  in  the  amount  or  nature  of  the  chemical  substances  pro- 
moting oxidation  that  also  determine  the  rate  of  its  occurrence. 


Temperature  119 

The  friction  within  the  body  caused  by  the  move- 
ments of  the  muscles,  circulation  of  the  blood,  and 
other  internal  activities ;  the  hot  foods  and  drinks 
that  are  taken;  the  heat  received  from  such  ex- 
ternal sources  as  the  sun  and  fires. 

Heat  is  lost  from  the  body  chiefly  through  the 
skin  but  also,  to  a  slight  extent,  through  the  lungs 
and  with  the  urine  and  feces.  Its  loss  through  the 
skin  is  affected  by  conduction  and  radiation  and 
by  the  evaporation  of  sweat.  The  amount  lost 
by  conduction  and  radiation  depends  chiefly  upon 
(i)  the  amount  of  blood  near  the  surface  of  the 
body,  being  greater,  of  course,  when  there  is  a 
large  amount  of  blood  in  the  skin  vessels;  (2)  the 
temperature  of  the  environment,  hot  surroundings 
interfere  with  the  passage  of  heat  from  the  body 
(the  reasons  for  this  were  given  in  Chapter  I),  and 
cold,  by  contracting  the  superficial  muscles  and 
blood-vessels,  forces  much  of  the  blood  to  the  in- 
terior of  the  body.  Loss  of  heat  by  evaporation  of 
sweat  occurs  because  heat  is  essential  for  evapo- 
ration and  that  required  is  taken  from  the  body. 
536  small  calories  or  0.536  of  a  large  Calory  are 
necessary  for  the  evaporation  of  one  gram  of  water 
and  approximately  nine  hundred  (about  one  quart) 
grams  of  perspiration  are  secreted  daily. 

Ordinarily  we  are  unconscious  of  this  secretion 
because  the  rate  of  evaporation  keeps  pace  with 
that  of  secretion  and,  on  a  hot  day,  if  the  humidity 
is  not  high,  a  much  larger  quantity  can  be  secreted 
without  becoming  visible  or  being  felt,  because 


120  Nursing  Methods 

heat  hastens  evaporation,  but,  humidity  interferes 
with  evaporation  (for  reason  given  in  Chapter  I) 
and,  consequently,  with  loss  of  the  heat  from  the 
body  by  evaporation. 

The  heat  lost  through  the  lungs  also  is  largely 
due  to  its  use  for  vaporization,  for  during  twenty- 
four  hours  as  much  as  a  pint  of  water  leaves  the 
body  as  vapor  in  the  breath. 

To  summarize  the  process  of  heat  regulation: 
Cold  causes  muscular  contraction,  drives  the  blood 
from  the  surface  of  the  body,  and  lessens  perspira- 
tion; thereby,  it  increases  heat  production  and 
lessens  heat  loss.  When  the  temperature  of  the 
blood  is  raised,  either  as  the  result  of  increased 
oxidation  or  from  hot  surroundings,  the  skin  vessels 
dilate  and  more  blood  flows  to  the  exterior,  the 
secretion  of  perspiration  is  stimulated  and  the 
muscles  relax;  therefore,  loss  of  heat  is  promoted 
and  its  production  decreased.  Consequently,  the 
temperature  of  a  healthy  person  remains  normal, 
regardless  of  changes  in  the  external  temperature, x 
unless  the  change  is  excessive. 

Fever 

Fever  is  defined  as  abnormally  high  body  tempera- 
ture. The  rise  of  temperature  is  brought  about  by 

1  The  body  temperature  of  some  of  the  lower  forms  of  animal  life 
varies  with  that  of  their  environment;  thus  a  frog's  temperature  in 
winter  may  be  five  degrees  centigrade  and  in  summer  twenty-five 
degrees  centigrade  or  over  and  the  vitality  of  its  tissues  will  not  be 
impaired  by  this  wide  fluctuation.  In  higher  forms  of  animal  life, 
however,  such  a  fluctuation  would  be  incompatible  with  life. 


Temperature  121 

disturbance  between  the  production  and  loss  of 
heat.  The  nature  of  this  disturbance  varies  some- 
what as  in  some  cases  it  is  due  chiefly  to  over  pro- 
duction and  in  others  to  interference  with  loss  of 
heat.  This  derangement  in  heat  regulation,  how- 
ever, only  lasts  for  a  short  time  for  the  heat  regu- 
lating center  eventually  again  assumes  control  but, 
as  long  as  there  is  fever,  the  center  is  set  for  a 
higher  scale  of  temperature  so  that,  instead  of 
responding  to  a  temperature  between  99°  and  100° 
F.  (the  ordinary  actual  temperature  of  the  blood), 
it  is  only  called  into  action  by  a  higher  tempera- 
ture, x  the  degree  depending  upon  the  cause  of  the 
fever  and  the  patient's  condition,  but,  even  in  fever 
there  is  adjustment.  This  is  much  less  stable, 
however,  than  in  health  for  there  are  often  wider 
variations  in  the  diurnal  fluctuations  and  changes 
of  external  temperature  and  other  stimuli  more 
easily  depress  or  increase  the  temperature  than  in 
health. 

The  cause  for  the  heat-regulative  upset  is  not 
definitely  known ;  one  of  the  theories  that  has  been 
advanced  is  that  the  heat  centers  are  depressed  by 

1  The  heat  regulating  center  is  often  likened  to  the  adjuster  of 
an  electric  oven.  If  the  indicator  of  the  adjuster  is  set,  for  ex- 
ample, at  ninety-eight,  so  soon  as  the  oven  reaches  ninety-eight 
degrees  the  electric  connection  is  automatically  severed  by  the 
adjuster  and  remains  so  until  the  temperature  falls,  when  it  is 
again  remade  by  the  adjuster,  and  thus  a  constant  temperature 
of  ninety -eight  is  maintained  in  the  oven;  but  if  the  indicator  is 
set  for,  say,  four  hundred,  this  will  be  the  temperature  maintained 
in  the  oven. 


122  Nursing  Methods 

the  action  upon  them  of  bacterial  toxins,  or  in  non- 
bacterial  diseases,  the  conditions  causing  the  ill- 
ness ;  but  it  is  now  thought  that  there  are  also  other 
factors  involved;  these,  however,  are  too  compli- 
cated to  be  discussed  here. 

Fever,  though  a  symptom  of  abnormal  body 
conditions,  is  now  thought  to  be  one  of  nature's 
methods  of  protecting  the  body  from  such  condi- 
tions. An  experiment  that  has  been  tried  re- 
peatedly has  consisted  in  putting  rabbits,  or  other 
small  animals,  into  hot  surroundings  until  their 
temperature  rose  to  about  40°  C.  and  then  in- 
jecting them,  and  also  similar  animals  that  had  not 
been  heated,  with  bacterial  toxins.  In  almost  all 
instances  all  the  animals  that  were  not  heated  have 
shown  bad  results  and  died  from  the  effects  of  the 
toxins  before  those  who  had  the  high  temperature 
at  the  time  of  injection.  Nevertheless,  fever  can 
become  so  high  that  it  will  add  to  the  danger  of  the 
patient's  condition. 

The  toxins  produced  by  the  various  species  of 
bacteria  and  diverse  abnormal  body  conditions 
differ  one  from  the  other  and  they  induce  different 
conditions  or  symptoms  in  the  body,  including  the 
course  of  the  temperature,  and  therefore  knowl- 
edge of  the  changes  in  the  temperature  helps  the 
doctor  to  decide  what  is  the  matter  with  the  patient 
and  the  progress  of  the  disease. 

The  terms  used  in  describing  different  de- 
grees of  temperature  are  shown  in  the  following 
table: 


Temperature  123 

Fahrenheit  Centigrade 

Hyperpyrexia  106°  and  over  41° 

High  fever  103°  -  106°  39°   -41° 

Moderate  fever  101°  -  103°  38°  -39° 

Subfebrile  99°  -  101°  37°   -38° 

Normal  98°  -     99°  36.5°-37° 

Subnormal  96°  -    97°  35-5°-36° 

Collapse  95°  -    96°  35°  -35.5° 

Algid  collapse  Below      95°  Below    35° 

Nature  and  Care  of  Thermometers 

The  thermometers  used  for  ascertaining  the 
body  temperature  are  known  as  clinical1  ther- 
mometers. A  clinical  thermometer  consists  of  a 
glass  tube  of  capillary2  bore  with  a  bulb,  filled  with 
mercury,  on  one  end.  When  a  thermometer  is 
made  the  bulb  and  part  of  the  tube  are  filled  with 
mercury  and  the  instrument  is  heated  until  the 
mercury  boils  over  and  thus  forces  the  air  from  the 
tube.  The  open  end  of  the  tube  is  then  sealed. 
When  the  tube  is  cold  it  is  placed  in  boiling  water 
and  the  point  to  which  the  mercury  rises  is  marked 
212,  if  the  thermometer  is  to  be  marked  according 
to  the  Fahrenheit  scale,  or  100,  for  the  centigrade 
scale.  The  bulb  is  next  placed  in  a  vessel  of  melt- 
ing ice  and  the  point  at  which  the  mercury  stops 
is  marked  32  for  the  Fahrenheit  scale  and  o  for 
the  centigrade.  The  space  between  the  boiling  and 
freezing  temperatures  is  then  marked  at  regular  in- 
tervals, the  number  and  size  of  the  divisions  made 

1  From  a  Greek  word  signifying  at  the  bedside. 
1  From  the  Latin  capillaris  =  hair-like. 


124  Nursing  Methods 

depending  upon  which  scale  is  used.  The  value  of 
the  thermometer  depends  upon  the  expansion  of 
the  mercury  by  heat  which  causes  it  to  rise  in  the 
tube  and,  as  the  expansion  is  always  in  proportion 
to  the  degree  of  heat,  to  which  the  mercury  is 
subjected,  the  height  to  which  it  rises  in  the  tube 
shows  the  temperature. 

When  not  in  use  a  thermometer  is  best  kept  in  a 
case  but,  when  it  is  being  used  for  a  patient,  it  is 
more  hygienic  to  keep  it  in  a  glass  of  water  or,  if 
the  patient  has  an  infectious  disease  or  the  ther- 
mometer is  used  for  more  than  one  person,  in  a 
disinfectant.  A  pad  of  soft  material,  as  cotton, 
gauze,  or  muslin,  should  be  kept  in  the  bottom  of 
the  glass,  because  the  bulb  is  likely  to  be  broken  if 
it  comes  in  contact  with  anything  hard.  The  glass 
should  be  kept  covered  with  a  compress  of  gauze 
or  muslin  and  the  thermometer  wiped  on  this 
before  use.  A  thermometer  should  be  well  washed 
with  alcohol  or  other  disinfectant  before  it  is 
returned  to  its  case. 

Clinical  thermometers  are  self -registering — i.  e., 
the  mercury  stays  at  the  height  to  which  it  ascends 
until  it  is  shaken  down.  Therefore,  before  using 
a  thermometer,  it  is  necessary  to  see  if  the  mercury 
is  down  to  95°  F.  and  if  not  to  shake  it  down  to  that 
point. 

To  shake  down  the  mercury,  hold  the  thermome- 
ter between  the  thumb  and  the  first  and  second 
fingers  of  the  right  hand,  with  the  bulb  pointing 
downward,  flex  the  hand  somewhat  and  give  it  a 


Temperature  125 

quick,  sharp  Jerk.  Be  careful  not  to  shake  the  mer- 
cury below  95°  for  if  it  all  gets  into  the  bulb  it  may 
not  be  possible  to  make  it  rise  again.  To  try  and 
make  it  do  so,  put  the  bulb  into  water  about  108°  F. 

The  temperature  is  taken  in  either  the  mouth, 
rectum,  or  axilla,  for  these  locations  form  more  or 
less  closed  cavities  in  which  large  blood-vessels 
approach  the  surface.  For  obvious  reasons,  the 
temperature  taken  by  rectum  will  be  registered 
about  a  degree  higher,  and  that  taken  by  axilla 
about  %  degree  lower,  than  that  taken  by  mouth. 
It  is  necessary  to  leave  the  thermometer  in  place 
for  a  longer  time  when  it  is  put  in  the  axilla  than 
when  it  is  inserted  in  the  rectum  or  mouth. 

There  is  less  chance  of  error  when  the  tempera- 
ture is  taken  by  rectum  and  thus  it  usually  is  taken 
in  this  way  when  a  patient  is  very  ill,  except  when 
there  are  abnormal  conditions  of  the  rectum ;  also 
the  temperature  of  a  young  child  is  best  taken  in 
this  way.  As  this  will  probably  be  the  only  rectal 
temperature  that  the  students  of  this  class  will  be 
likely  to  take,  unless  they  receive  further  instruc- 
tion, it  will  be  described  in  the  chapter  dealing  with 
the  care  of  children. 

Demonstration  12 
Taking  the  Temperature  by  Mouth  and  by  Axilla 

Equipment:  I.  Clinical  thermometers  in  a  glass 
containing  a  disinfectant  and  a  soft  pad  in  the 
bottom. 


126  Nursing  Methods 

2.  Several  small  pieces  of  soft,  clean  muslin  or 
gauze  on  which  to  wipe  the  thermometers. 

3.  A  few  towels. 

4.  A  clock  or  watches. 

5.  Pad  on  which  to  record  the  temperature. 

6.  Pens. 

Procedure  when  taking  the  temperature  by 
mouth:  Take  the  thermometer  from  the  solution, 
wipe  it,  shake  it  down  if  necessary,  as  described 
on  page  124,  place  it,  in  a  slanting  position,  under 
the  tongue.  Tell  the  patient  to  keep  her  mouth 
tightly  closed.  Leave  it  in  place  three  minutes. 
Remove  it,  wipe  it,  read  it,  put  it  in  the  solu- 
tion. 

Record  the  temperature. 

Points  to  remember:  A  mouth  temperature 
should  not  be  taken  within  ten  minutes  of  the  time 
that  the  patient  has  had  anything  hot  or  cold  in 
the  mouth. 

The  temperature  is  not  to  be  taken  by  mouth 
when  the  patient  is  coughing,  has  dyspnea,  is  un- 
conscious, delirious,  insane,  or  too  young  to  under- 
stand what  she  is  to  do. 

Do  not  leave  the  thermometer  in  the  mouth 
longer  than  three  minutes. 

Should  a  patient  bite  the  bulb  off  the  thermome- 
ter, make  her  at  once  spit  out  the  glass  and  mer- 
cury and  be  sure  that  no  particles  are  left  in  her 
mouth.  The  physician  should  be  notified.  The 
danger  attending  this  accident  is  that  small  par- 
ticles of  glass  may  be  swallowed.  Mercury  in  its 


Pulse  127 

metallic  form  is  inert  and,  therefore,  would  prob- 
ably do  no  harm,  even  if  swallowed,  but  white  of 
egg,  which  contains  albumen,  the  chemical  antidote 
for  mercury,  is  usually  given  as  a  precautionary 
measure. 

Procedure  in  taking  the  temperature  by  axilla: 
Wipe  the  axilla  with  a  towel.  Shake  down  the 
mercury. 

Place  the  bulb  of  the  thermometer  in  the  hollow 
of  the  axilla  with  the  stem  pointing  toward  the 
chest,  bring  the  arm  across  the  chest,  and  instruct 
the  patient  to  hold  it  pressed  closely  to  her  body; 
unless  she  can  do  so  without  undue  effort,  keep 
your  hand  upon  her  arm. 

Remove,  wipe,  and  read  the  thermometer,  put 
it  in  the  disinfectant,  and  record  the  temperature 
at  once. 

Pulse 

By  the  pulse  is  meant  the  distention  of  the 
arteries  that  occurs  when  blood  is  pumped  into 
them  from  the  heart. 

This  distention  or  pulsation  may  be  felt  where- 
ever  an  artery  approaches  the  surface  of  the  body 
over  a  bone,  the  latter  is  necessary  to  afford  a  firm 
background  against  which  to  make  pressure.  For 
convenience,  however,  the  pulse  is  usually  counted 
on  the  radial  artery1  where  it  comes  near  the  sur- 
face at  the  wrist. 

1  The  large  artery  on  the  thumb  side  of  the  forearm. 


128  Nursing  Methods 

There  are  a  number  of  things  that  a  nurse  is 
taught  to  observe  when  "taking  the  pulse, "  but  as 
to  be  able  to  recognize  most  of  them,  requires 
considerable  experience  with  sick  people,  the  rate 
and  force  or  strength  will  be  the  only  ones  dis- 
cussed here.  To  understand  even  these  it  is  neces- 
sary to  know  the  following  facts  regarding  the 
structure  of  the  heart  and  functions  of  the  blood- 
vessels : 

The  heart  is  a  hollow  muscular  organ  with  a 
muscular  wall  dividing  its  interior  into  two  distinct 
cavities  and  each  of  these  two  cavities  is  separated 
by  movable  flaps  of  membrane,  known  as  valves, 
which  open  when  blood  is  flowing  from  the  upper 
to  the  lower  divisions.  The  upper  divisions,  i.  e., 
the  part  above  the  valves,  on  each  side  of  the  heart, 
are  known  as  the  right  and  left  auricles,  and  the 
divisions  below  the  valves  as  the  right  and  left 
ventricles.  The  blood  enters  the  auricles  from  six 
large  veins,  two  of  which  open  into  the  right  auricle 
and  four  into  the  left .  The  blood  entering  the  right 
auricle  has  come  from  all  parts  of  the  body  to 
which  it  has  given  much  of  its  oxygen  and  from 
which  it  has  received  carbon  dioxid  and  other 
waste  matter.  That  entering  the  left  auricle  has 
come  from  the  lungs,  where  it  has  given  up  a  large 
proportion  of  carbon  dioxid  and  received  oxygen. 
From  the  auricles,  the  blood  flows  into  the  ven- 
tricles and  from  the  right  ventricle  it  is  forced  into 
the  pulmonary  artery  from  which  branches  extend 
to  the  lungs,  and  from  the  left  ventricle  it  is  forced 


Pulse 


129 


into  the  large  artery  known  as  the  aorta  from 
which  branches  extend  to  all  parts  of  the  body. 
Thus,  to  summarize,  the  blood  flows  from  the  left 
auricle  into  the  left  ventricle,  from  the  left  ventricle 


EXTERIOR  INTERIOR  OF  RIGHT  SIDE 

Fig.  27.     The  Heart.     Showing  cavities  of  the  right  auricle  and  right  ventricle. 

into  the  aorta,  and  thence  all  over  the  body;  from 
arteries  the  blood  passes  into  capillaries  and  from 
these  into  veins,  and  veins  in  all  parts  of  the  body 
communicate  directly  or  indirectly  with  one  or 
other  of  the  two  large  veins  that  enter  into  the 
right  auricle.  From  this  the  blood  is  poured  into 
the  right  ventricle  and,  at  the  same  time  as  the 
blood  in  the  left  ventricle  is  being  forced  into  the 


130  Nursing  Methods 

aorta,  that  in  the  right  is  forced  into  the  pulmonary 
artery  from  which  it  flows  to  the  lungs  to  get  rid 
of  carbon  dioxid  and  obtain  a  fresh  supply  of 
oxygen  for  the  body.  From  the  lungs  it  is  returned 
to  the  left  auricle. 

From  the  time  that  the  organs  concerned  with 
the  circulation  of  the  blood1  are  formed,2  until 
death,  the  heart  is  constantly  alternately  contract- 
ing and  relaxing  with  a  very  short  period  of  rest3 
between  the  relaxing  and  subsequent  contraction. 
When  the  heart  is  beating  more  rapidly  than  usual 
it  is  chiefly  the  rest  period  and  time  of  relaxing 
that  are  shortened.  Thus  when  the  pulse  is  ab- 
normally rapid,  the  heart  is  losing  its  rest  and  also 
its  nutriment,  for  the  heart  muscle  gets  its  blood 
supply  from  small  vessels  that  run  through  its 
substance  and  these,  like  the  cavities,  are  emptied 
when  the  heart  contracts. 

The  normal  rate  of  the  heart  can  be  seen  by  the 
following  table.  As  shown  there,  sex  and  age  are 
responsible  for  a  certain  amount  of  difference. 

In  men 60-  70  beats  per  minute 

"  women 65-  80 

"  children  above  7  yrs 72-  90 

"  children  1-7  yrs 80-120 

"  infants 110-130 

At  birth 130-160 


1  Heart,  arteries,  capillaries,  veins. 

2  Some  months  before  birth. 

*  About  o.i  to  0.2  of  a  second  when  the  pulse  rate  is  72  per 
minute. 


Pulse  131 

The  rate  of  the  heart  action  is  controlled  by 
impulses  coming  from  the  brain  over  two  different 
sets  of  nerve  fibers  and  when  one  of  these,  known 
as  the  cardiac1  accelerator,  is  stimulated,  it  makes 
the  heart  beat  faster  while  stimulation  of  the  other 
group,  known  as  the  cardiac  inhibitory  mechanism, 
slows  the  heart  action. 

Some  of  the  common  causes  of  stimulation  of 
the  accelerator  mechanism  and,  consequently,  of 
increase  in  the  rate  of  the  pulse  are :  Fear,  anger, 
excitement,  or  any  other  strong  emotion,  bodily 
activity,  fever.  The  rate  of  the  pulse  is  also  in- 
creased by  depression  of  the  inhibitory  mechanism 
and  by  conditions  that  prevent  the  heart  contract- 
ing firmly,  such  as  a  diseased  or  weakened  heart, 
relaxed  blood-vessels,  a  deficiency  of  blood  in  the 
vessels,  such  as  is  the  case  after  hemorrhage  or 
when  the  blood-vessels  become  so  relaxed  that  the 
arteries  do  not  force  enough  blood  onward  through 
the  capillaries  and  veins  to  the  heart.  Also  a 
person's  position,  lying,  sitting,  standing,  causes 
some  change  ki  the  pulse  rate,  partly  because  in 
the  two  postures  last  mentioned  the  blood  has  to 
be  forced  to  the  parts  above  the  heart  against 
gravity.  Even  in  health,  the  pulse  may  be  as 
much  as  five  beats  more  per  second  when  a  person 
is  sitting  up  than  when  lying  down  and  thus  a 
patient's  heart  may  be  spared  at  least  21.600  beats 
a  day  if  she  is  kept  lying  quietly  in  bed.  This  is 
very  important  when  the  heart  is  beating  too 

1  From  the  Greek,  kardia  —  the  heart. 


132  Nursing  Methods 

rapidly  and  thereby  losing  its  chance  to  get  suf- 
ficient rest  and  nutriment. 

For  two  reasons  it  is  very  important  to  remember 
that  excitement  increases  the  heart  rate  (i)  in 
order  to  realize  the  importance  of  shielding  the 
patient  from  undue  excitement  and  annoyance; 
(2)  to  appreciate  that  if  a  patient's  pulse  is  counted 
while  she  is  excited  the  count  will  not  show  the 
ordinary  rate  of  the  heart  action  at  the  time,  and, 
as  relative  changes  in  temperature  and  pulse  are 
an  important  guide  to  the  physician  in  judging  of 
a  patient's  condition,  when  there  is  any  known 
cause  for  increase  in  the  pulse  rate  at  the  time  it  is 
counted  the  fact  should  be  stated. 

Breathing  and  Respiration 

By  breathing  is  meant  the  movements  of  the 
chest  walls,  diaphragm,  and  lungs  which  result  in 
the  inspiration  of  fresh  air  and  expiration  of  that 
not  used  and,  with  it,  the  gases  brought  from  the 
tissues  to  the  lungs  by  the  blood. 

Respiration1  implies  (i)  the  interchange  of  gases 
that  takes  place  in  the  lungs — this  is  known  as 
external  respiration — and  consists  in  the  passage 
of  oxygen  from  the  inspired  air  into  the  blood  and 
its  union  there  with  what  is  known  as  hemoglobin 
(which  is  contained  in  the  red  corpuscles2)  and  the 

1  This  is  now  considered  the  correct  significance  of  the  term 
respiration,  but  the  word  is  very  commonly  used  as  a  synonym 
for  breathing. 

» If  not  understood,  see  footnote  on  page  135. 


Respiration  133 

passage  of  water  and  carbon  dioxid  from  the  blood 
into  the  air  sacs1  of  the  lungs  from  which  it  is  ex- 
pelled in  expiration;  (2)  the  interchange  of  gases 
between  the  blood  and  the  tissues  (known  as  in- 
ternal respiration)  in  which  oxygen  leaves  the 
blood  and  passes  into  the  tissues  and  carbon  dioxid 
passes  from  the  tissues  into  the  blood. 

The  principal  factor  maintaining  breathing  is 
the  carbon  dioxid  in  the  blood  which  stimulates  a 
small  mass  of  gray  matter  contained  in  a  portion 
of  the  brain  known  as  the  medulla  oblongata.  This 
is  connected  by  nerve  fibers  with  the  spinal  cord 
from  which  fibers  extend  to  the  muscle  tissue  of  the 
diaphragm2  and  to  muscles  of  the  chest.  It  is 
stimulated  by  the  carbon  dioxid  in  the  blood  pass- 
ing through  it  and  the  impulses  thus  evoked  con- 
tract the  muscles  involved  in  breathing  and,  as  a 
consequence,  the  diaphragm  is  pulled  downward 
in  the  center  and  the  ribs  are  pulled  upward  and 
outward,  thus  the  chest  cavity  is  very  considerably 

1  The  lungs  consist  chiefly  of  air-passages  which  end  in  minute 
sacs  of  exceedingly  thin  membrane,  and  of  blood-vessels  held 
together  with  a  very  thin,  elastic  fibrous  tissue.    The  walls  of  the 
air  sacs  and  of  the  capillaries  upon  their  surface  are  exceedingly 
thin  and  gases  can  pass  through  them  readily.    At  the  rate  at 
which  the  blood  ordinarily  flows  through  the  body  it  takes  less 
than  a  minute  for  the  entire  amount  of  blood  in  the  body  to  flow 
to  and  through  the  lungs. 

2  The  dome- shaped  partition  between  the  thoracic  (chest)  and 
abdominal  cavities.    Its  central  portion  consists  of  non-contractile 
fibrous  tissue  and  this  is  surrounded  with  muscle  that  is  attached 
to  the  ribs,  vertebrae,  etc.,  forming  the  lower  boundary  of  the 
thoracic  framework.    See  Fig.  28. 


i34  Nursing  Methods 

enlarged  and,  as  the  lungs  expand  in  keeping  with 
the  chest  wall,  there  is  a  partial  vacuum  created 
in  the  air  passages  and  sacs  which  the  outside  air  is 
pressed  in  to  fill.  This  constitutes  what  is  known 


Fig.  28.    Diaphragm,  viewed  from  the  front.     (Garish.)     The  ribs 
have  been  cut  away  in  front. 

as  inspiration.  It  is,  as  stated  above,  followed  by 
the  recoil  of  the  muscles  involved  and  relative  com- 
pression of  the  lungs  which  constitute  expiration. 
When  anything  interferes  with  the  normal  aeration 
of  the  blood,  more  muscles  are  brought  into  play 
than  are  used  in  ordinary  breathing  and  expiration 
has  a  more  forceful  character. 
The  rate  of  breathing  can  be  controlled  for  a 


Respiration  135 

few  minutes  by  voluntary  effort,  but  not  for  long. 
It  is  determined  chiefly  by  the  amount  of  carbon 
dioxid  in  the  blood  and,  therefore,  it  will  be  in- 
creased by  anything  that  accelerates  the  oxidation 
in  the  tissues,  and  also  by  anything  that  tends  to 
hinder  the  blood  getting  its  required  amount  of 
oxygen,  and  getting  rid  of  surplus  carbon  dioxid. 
Such  interference  with  the  proper  aeration  of  the 
blood  may  result  from1  any  congestion  or  obstruc- 
tion in  the  lungs  or  the  upper  air  passages  leading 
to  them;  (2)  a  lack  of  red  corpuscles  or  of  hemo- 
globin in  the  blood2;  (3)  interference  with  the  cir- 
culation of  the  blood  in  the  lungs  as  may  occur 
when  the  heart  is  diseased  or  the  nervous  system 
is  depressed. 

Also,  the  depth  of  breathing  movements  influ- 
ences their  rate,  relatively  slow  movements 
being  associated  with  deep  breathing  and  rapid 
movements  with  shallow  inspirations.  Common 
causes  of  shallow  breathing  are:  Thoracic  or  ab- 
dominal pain,  lack  of  oxygen  in  the  room,  reduced 
air  pressure  (as  in  high  mountains),  tight  clothing, 
and  habit,  the  latter  being  probably  often  the 
result  of  tight  clothing  or  of  a  lazy  disposition. 

1  The  coloring  matter  in  the  red  blood  corpuscles. 

3  The  body's  oxygen  supply  is  very  greatly  influenced  by  the 
amount  of  hemoglobin  in  the  blood  and  by  atmospheric  pressure, 
and,  when  people  go  up  high  mountains,  they  are  likely  to  suffer 
from  air-hunger  for  the  first  few  days.  Usually,  however,  this 
stimulates  the  formation  of  hemoglobin  and  thus  more  oxygen 
can  be  absorbed  at  the  low  atmospheric  pressure.  This  stimula- 
tion of  hemoglobin  formation  is  largely  responsible  for  the  benefit 
anemic  people  gain  by  sojourn  in  the  mountains. 


136  Nursing  Methods 

As  the  rate  of  breathing  is  increased  when  it  is 
shallow,  if  there  is  nothing  to  interfere  with  the 
aeration  of  the  blood,  as  much  oxygen  will  be  ob- 
tained with  superficial  as  with  deep  breathing  but, 
nevertheless,  the  former  is  not  thought  to  be  as 
conducive  to  good  health  because  the  lower  areas 
of  the  lungs  are  not  expanded  as  they  should  be 
and,  as  the  circulation  of  blood  in  the  lungs  is 
helped  by  the  respiratory  movements,  the  un- 
expanded  areas  are  not  properly  nourished  and 
thus  are  less  able  to  resist  invasion  by  bacteria. 

As  can  be  seen  by  the  following  table  which 
shows  the  average  normal  frequency  of  breathing 
there  is  some  difference  in  the  rate  that  is  normal 
for  children  and  adults  and  men  and  women,  the 
latter  difference  however  is  thought  to  be  largely 
due  to  dissimilarity  in  dress. 

Men 16  to  18  per  minute 

Women 18  to  20    " 

Children 20  to  25    " 

Infants 30  to  35    " 

Demonstration  13 
Counting  the  Pulse  and  Breathing 

Articles  required:  I.  Watches  with  second 
hands. 

2.    Writing  pads  and  pens. 

The  pupils  can  act  as  subjects  for  each  other. 

Precautions :  Do  not  "take  the  pulse "  when  the 
patient  is  excited  or  other  conditions  exist  which 


Respiration 

will  cause  temporary  changes  in  it,  except  for  the 
purpose  of  noting  the  results  of  such  conditions 
upon  it,  see  page  132. 

Do  not  use  your  thumb  to  feel  a  patient's  pulse 
for  there  is  a  superficial  artery  in  it  and  you  might 
feel  your  own  pulse  instead  of  the  patient's. 

Do  not  make  too  strong  pressure  when  counting 
the  pulse  for,  if  the  pulsation  is  weak,  strong 
pressure  will  obliterate  it — this  is  a  common  fault 
of  beginners. 

When  taking  the  pulse  at  the  radial  artery,  let 
the  patient's  arm  rest  on  the  bed  or  a  table. 

When  taking  the  pulse  of  a  patient  for  the  first 
time  always  take  it  in  both  wrists  to  ascertain  if  it 
can  be  felt  equally  well  in  both  for,  sometimes, 
owing  to  an  unusual  distribution  of  the  arteries,  or 
of  some  pathological  condition,  there  is  an  appre- 
ciable difference  in  the  quality  of  the  pulsations  in 
the  two  arteries. 

The  method  and  frequency  of  breathing  can  be, 
to  some  extent,  controlled  voluntarily  and  some- 
times, possibly  without  intention,  it  will  be  done 
when  the  individual  knows  that  her  breathing  is 
being  counted;  therefore,  do  it,  if  possible,  without 
the  patient's  knowledge.  A  good  way  of  doing  so 
is  to  count  the  breathing  either  before  or  after  the 
pulse  and  to  pretend  to  be  counting  the  latter  while 
you  are  counting  the  breathing  movements.  When 
the  patient  is  in  bed  her  hand  may  be  held  as  shown 
in  Fig.  29,  for  the  chest  movements  can  then  be  felt 
as  well  as  seen  which  facilitates  counting  them. 


138  Nursing  Methods 

Procedure  when  "  counting  the  pulse  " :  See  that 
the  patient  is  resting  comfortably. 

Take  your  watch  in  one  hand  and  place  two  or 
three  fingers  over  the  artery,  making  slight  pres- 
sure; observe  the  general  character  of  the  pulse. 
Count  the  number  of  beats  occurring  in  one 
minute. 

Procedure  when  counting  the  breathing:  Place 
your  fingers  as  when  counting  the  pulse,  hold  your 
watch  where  you  can  see  its  second  hand  and  the 
patient's  chest  at  the  same  time.  Count  an  in- 
spiration and  expiration  as  one  breath.  Count  for 
one  minute. 

Records 

When  a  person  is  at  all  seriously  ill  a  written 
record  should  be  kept,  for  otherwise  something 
that  the  doctor  should  be  told  at  the  time  of  his 
visit  will  be  forgotten.  The  record  should  in- 
clude :  The  doctor's  orders ;  records  of  the  patient's 
temperature,  pulse,  and  breathing;  the  hours  at 
which  medicines  are  given  and  the  amounts  ad- 
ministered ;  pain  or  other  distress  that  the  patient 
complains  of  and  the  results  of  treatments  used  for 
relief ;  the  number  of  bowel  movements. 


CHAPTER  VIII 

Medication.    External  Applications. 
Irrigations 

Method  of  administering  drugs.  Bad  effects  that  may  arise 
from  the  unadvisable  use  of  drugs.  Important  points  to  be  re- 
membered regarding  the  care  and  administration  of  drugs. 
Measuring  medicines.  Application  of  medication  to  the  nose, 
throat,  ears,  eyes,  and  skin.  Demonstrations  14  to  21,  including: 
Measuring  medicines;  application  of  medication  to  the  throat  and 
steam  inhalations;  irrigation  of  the  ear;  application  of  medicine 
to  the  eyes;  making  poultices  and  sinapisms;  applying  ointment, 
liniments,  iodine,  fomentations,  hot-water  bags  and  substitutes, 
ice-caps  and  substitutes.  The  nature  and  uses  of  counter- 
irritants. 

The  lists  of  equipments  for  the  demonstrations 
are  on  pages  145,  154,  162,  167,  175,  182,  and  192. 

Medicinal  substances  are  used  to  cause  both 
local  and  general  or  systemic  effects.1  For  local 
effects  they  must  be  so  applied  that  they  will  come 
in  contact  with  the  part  that  they  are  to  act  upon ; 
for  systemic  effects  they  must  be  either  absorbed 
by  the  blood  or  act  upon  nerve  endings  and  thus 
obtain  results  through  the  nervous  system  as 
described  under  counter-irritation. 

•Those  acting  upon  the  whole  body  or  at  least  a  number  of 
organs,  especially  those  concerned  in  a  common  function. 

139 


140  Nursing  Methods 

Drugs  may  be  given:  by  mouth;  through  the 
lungs ;  by  rectum ;  as  subcutaneous,  intramuscular, 
and  intravenous  injections;  and  they  may  be 
applied  externally;  but  only  the  means  of  giving 
them  by  mouth  and  applying  them  externally  will 
be  considered  here,  because  the  other  methods  of 
administration  require  more  knowledge  and  prac- 
tice than  can  be  gained  in  a  short  nursing  course. 

Before  learning  how  to  administer  medicines  it 
is  well  to  realize  that  drugs  should  neither  be  taken 
nor  given  inconsiderately  because  there  is  hardly  a 
drug  that  has  not  some  bad  effect.  This  is  true 
even  of  drugs  that  are  very  commonly  taken  with- 
out consulting  a  physician,  viz.,  drugs  used  to 
relieve  headache  and  to  induce  sleep,  cathartics, 
and  tonics.  Other  reasons  why  it  is  unwise  to  take 
even  such  drugs  frequently  without  consulting  a 
doctor  are:  (i)  the  symptoms  that  the  drugs  are 
taken  to  relieve  may  be  due  to  serious  conditions 
and,  though  a  drug  may  temporarily  relieve  the 
pain  or  discomfort  that  the  condition  produces,  it 
does  not  cure  the  cause  and  this  may  continue  to 
grow  worse.  For  example,  common  causes  of 
frequent  headache  are:  (a)  Abnormal  conditions 
of  the  eyes ;  (b)  collections  of  pus  in  bones  behind 
or  at  the  side  of  the  nose,  or  at  the  roots  of  the 
teeth,  or  in  the  tonsils;  (c)  constipation;  (d)  disease 
of  the  kidneys ;  and  the  drugs  commonly  taken  to 
relieve  headache  cannot  improve  such  conditions 
though,  usually  by  depressing  the  nervous  system 
and  thus  lessening  the  appreciation  of  pain,  they 


Medication  I41 

may  alleviate  the  headache.  (2)  A  number  of  the 
drugs  which  alleviate  pain  (including  headache) 
and  induce  sleep  do  so  by  uniting  with  constituents 
of  the  nerve  tissue,  especially  that  of  the  brain,  and, 
if  they  are  used  frequently  they  may  cause  de- 
terioration of  the  tissue,  and  the  person's  mental 
capabilities  and  will-power  will  then  decline,  and 
any  or  all  of  the  organs  of  the  body  may  cease  to 
function  properly,  because,  as  previously  stated, 
their  functioning  is  controlled  by  the  nervous 
system.  Even  cathartics  and  tonics,  if  taken  too 
frequently,  may  cause  trouble.  Cathartics  so 
accustom  the  intestine  to  abnormal  irritation  that 
the  contraction  of  its  muscle  tissue,  which  propels 
the  waste  from  food  through  the  organ,  does  not 
occur  properly  without  the  extra  stimulus.  There- 
fore, taking  cathartics  too  frequently  may  be  a 
cause  of  chronic  constipation.  Thus  it  is  infinitely 
better  to  try  and  overcome  any  tendency  to  con- 
stipation by  natural  means,1  e.  g.,  eating  food  that 
has  a  considerable  amount  of  cellulose2  which  is  not 
digested,  e.  g.,  fruit  and  green  vegetables.  The 
food  supply  should  also  be  considered  when  a  tonic 

1  Constipation,  when  not  due  to  intestinal  disease,  is  generally 
the  result  of  (i)  a  diet  lacking  in  substances  that  are  not  digested 
and  thus  provide  the  bulk  necessary  to  stimulate  and  distend  the 
intestine  and  thereby  produce  the  nerve  impulses  that  induce  de- 
fecation; (2)  lack  of  tone  of  the  intestinal  or  abdominal  muscles, 
see  page  93 ;  (3)  failure  to  respond  to  the  sensation  arising  when 
the  rectum  is  ready  to  discharge  its  contents,  this  is  further 
described  on  page  216. 

3  The  fibrous  part  of  vegetables,  fruit,  and  grain. 


I42  Nursing  Methods 

seems  needed,  for  fresh  vegetables,  fruit,  eggs,  and 
milk  contain  many  of  the  constituents  of  tonics 
and  have  not  the  bad  effects  of  drugs.  Dried  and 
most  canned  vegetables  and  fruit  are  not  as  good 
as  fresh,  because  the  means  taken  to  preserve  them 
destroys  some  of  their  vital  principles. 

Some  important  points  to  remember  regarding 
the  care  and  administration  of  medicines  are : 

1 .  Never  leave  medicines  where  children  can  get 
them. 

2.  Do  not  keep  highly  poisonous  drugs,  such  as 
disinfectants,  on  the  same  shelf  as  others  unless  the 
bottles  are  of  very  different  size. 

3.  Never  have  medicines  in  unmarked  bottles. 

4.  Keep  oils  in  a  cold  place. 

5.  Do  not  use  a  drug  that  has  been  kept  for 
any  length  of  time  if  its  appearance  is  at  all 
changed,  for  many  drugs  deteriorate  with  age. 

6.  Give  medicines  on  time  and  be  especially 
particular  about  the  relative  time  of  meals  and 
medicine  because,  for  examples,  some  drugs  that 
are  ordered  given  before  meals  are  to  induce  the 
secretion  of  gastric  juice  and,  for  various  reasons, 
may  be  about  useless  if  given  while  the  stomach  is 
full  of  food  or  if  it  contains  acid,  as  it  does  during 
digestion;  on  the  other  hand  many  of  the  drugs 
ordered  to  be  given  after  meals  would  be  exceed- 
ingly irritating  to  the  lining  of  the  stomach  if  the 
latter  were  empty. 

7.  Use  graduated  glasses  and  pipettes  (medi- 
cine droppers)  not  spoons  for  measuring  medicines, 


Medication  143 

for  few  of  the  latter  are  of  standard  size  and  quite 
a  number  of  medicines  will  stain  metal. 

8.  Measure  exactly,  never  give  a  patient  a  drop 
more  or  less  than  the  doctor  orders. 

9.  If  there  is  more  than  one  medicine  on  hand, 
read  the  label  on  the  bottle  twice,  before  and  again 
after  pouring  the  drug. 

10.  Shake  the  bottle  before  pouring  out  a  medi- 
cine that  is  not  perfectly  clear  or  that  has  a  sedi- 
ment. 

11.  While  pouring  a  medicine,  hold  the  glass 
with  the  mark  of  the  quantity  required  on  a  level 
with  your  eye ;  if  the  mark  is  above  your  eye,  you 
will  give  too  little,  if  below,  too  much. 

12.  To  avoid  defacing  the  label  on  a  bottle 
while  pouring  the  medicine,  hold  the  bottle  so  that 
the  label  will  be  on  the  upper  side,  but  do  not  let 
your  hand  come  in  contact  with  it,  and,  before 
putting  away  the  bottle,  be  sure  that  there  are  no 
drops  on  the  rim. 

13.  Always  recork  a  bottle  immediately  after 
pouring  out  the  drug  for  many  medicines  contain 
volatile  substances  and  may  thus  become  either 
stronger  or  weaker  if  left  uncorked. 

14.  Always  follow  the  instruction   regarding 
the  dilution  of  drugs,  because  some  drugs  are  very 
irritating  and  may  do  great  harm  to  the  membrane 
lining  of  the  stomach  and  intestine  if  not  very  well 
diluted,  while  the  effect  of  others  will  be  minimized 
if  much  water  or  other  diluent  is  added  to  them; 
certain  medicines,  especially  syrup  cough  mixtures 


144  Nursing  Methods 

are  not  to  be  diluted  at  all  for  the  syrup  lubricates 
the  irritated  membrane  of  the  throat. 

15.  A  certain  class  of  drugs,  known  as  bitters, 
produce  their  effect  (stimulation  of  the  appetite 
and  secretion  of  saliva  and  gastric  juice)  by  virtue 
of  their  bitter  taste  and  thus  nothing  should  be 
done  to  alter  this  further  than  diluting  the  drug 
with  cold  water.  Other  drugs,  however,  should 
be  made  as  palatable  as  possible.  Powders  and 
also  liquid  preparations  of  which  only  a  small 
amount  is  ordered  can  be  given  in  capsules  or, 
especially  for  children,  in  syrup  or  jam.  Castor 
oil1  is  probably  the  medicine  that  has  most  fre- 
quently to  have  its  taste  disguised  and  a  good  way 
of  doing  this  is  to  put  some  lemon  or  orange  juice 
and  a  small  piece  of  ice  in  a  medicine  glass,  add  the 
oil  and  then  some  more  fruit  juice  and,  just  before 
the  patient  is  ready  to  drink  it,  some  Vichy  or  other 
effervescing  water.  The  piece  of  ice  should  be 
about  the  size  of  a  pea  when  the  patient  takes  the 
dose,  that  is  it  must  be  small  enough  to  swallow 
easily.  Have  a  glass  of  lemonade  or  orangeade 
ready  for  the  patient  to  take  as  soon  as  she  swal- 
lows the  oil.  Some  people  object  to  the  mineral 
oils  which  are  now  much  used  as  cathartics,  and 
for  those  who  do,  it  is  well  to  add  a  little  lemon 
or  orange  juice  or  peppermint  water  or  some 
flavoring  extract.  Holding  a  small  piece  of  ice 
in  the  mouth  before  taking  a  distasteful  dose 

1  N.B.  Never  give  castor  oil  in  milk,  especially  to  children, 
for  it  may  cause  the  recipient  to  dislike  milk. 


Medication  145 

may  be  of  help  for  cold  depresses  the  taste  nerve 
endings. 

1 6.  Give  acids  and  medicines  containing  iron 
through  a  tube,  because  acids  may  corrode  and 
iron  discolor  the  teeth.  The  mouth  should  be 
thoroughly  rinsed  after  taking  such  medicines. 


Demonstration  14 
Measuring  Medicine 

Equipment:  I.  Ordinary  graduated  medicine 
glasses,  minim  glasses,  medicine  droppers  (pi- 
pettes) . 

2.  A  pitcher  of  ice  water. 

3.  Some  bottles  of  water  or  other  substitute  to 
represent  medicine. 

4.  Small  trays. 

5.  Small  pieces  of  old,  clean  muslin  or  gauze. 

Procedure:  Take  a  medicine  glass  in  the  left 
hand  and  (after  reading  the  label),  the  medicine 
bottle  in  the  right. 

Shake  the  bottle  if  necessary. 

Take  the  cork  between  the  third  and  fourth 
fingers  of  the  left  hand  and  hold  it  thus  (with 
the  part  that  goes  in  the  bottle  projecting  from 
behind  the  hand)  while  you  pour  out  the 
medicine. 

Raise  the  glass  until  the  mark  representing  the 


146 


Nursing  Methods 


amount  of  drug  that  is  to  be  given  is  on  a  level 
with  your  eyes. 

Pour  in  the  drug  until  it  is  on  a  line  with  this 
mark. 

Put  the  glass  on  the  tray. 

Recork  the  bottle,  read  the 
label,  wipe  the  rim  of  the 
bottle  if  necessary,  and  put 
the  bottle  away. 

Pour  some  ice  water  into 
the  medicine. 

Fill  a  medicine  glass  with 
ice  water  and  put  it  on  the 
tray,  carry  the  tray  and  its 
contents  to  the  patient. 

When  the  medicine  is 
to  be  measured  by  drops, 
proceed  as  just  described 
with  the  following  excep- 
tions: Leave  the  bottle  on  the  table  and,  after 
removing  the  cork,  fill  the  pipette, — to  do  this, 
put  its  point  into  the  medicine,  expel  the  air  from 
its  tube  by  pressing  the  bulb,  and  then  release  the 
pressure,  whereupon  the  medicine  will  be  forced 
into  the  tube  (because  the  air  having  being  re- 
moved, there  will  be  no  pressure  within  the 
tube  to  oppose  the  pressure  of  the  liquid  in  the 
bottle). 

Wash  the  glasses,  etc.,  and  put  them  away.  If 
the  glasses  are  dried,  the  drying  should  be  done 
with  either  a  special  towel  or  a  dish  towel. 


Fig.  jo.  Method  of  hold- 
ing cork  and  glass  while 
pouring  medicine. 


Medication  147 

Local  Applications 

Local  applications  are  made  to  wounds,  the  skin 
and  cavities  that  communicate  with  the  exterior; 
e.  g.,  nose,  throat,  eyes,  ears. 

Applications  to  the  nose  are  usually  made  either 
by  spraying,  douching,  painting,  or  inhalation. 

The  two  methods  of  treatment  first  mentioned 
are  attended  with  considerable  danger  and  should 
only  be  given  to  patients  by  those  who  thoroughly 
understand  the  technic.  There  is  somewhat  less 
danger  in  their  personal  use  but  even  thus  they 
must  be  used  with  caution  and  under  the  direction 
of  a  doctor.  The  chief  dangers  attending  the  treat- 
ments are:  (i)  If  liquid  is  sprayed  from  an  atomi- 
zer into  the  nose  with  force,  infective  material  in 
the  nose  may  be  forced  through  the  minute  canals 
that  lead  from  the  nose  into  cavities  that  exist  in 
some  of  the  bones  of  the  face  and  thus  cause  a  seri- 
ous infection;  (2)  unless  the  solution  used  in  the 
spray  or  douche  is  of  the  right  concentration  and 
alkalinity,  it  may  irritate  the  lining  of  the  nose 
injuriously;  (3)  in  the  use  of  the  nasal  douche 
infected  matter  may  be  driven  into  what  are  known 
as  the  Eustachian  tubes,  two  small  canals  that 
lead,  one  on  each  side,  from  the  throat  to  the 
middle  cavity  of  the  inner  ear.  The  result  of  such 
infection  may  be  very  serious  indeed. 

Thus,  to  repeat,  these  treatments  should  not  be 
used  unless  prescribed  by  the  doctor  and  only  the 
solution  prescribed  is  to  be  used  and  the  tempera- 


Nursing  Methods 

ture  of  the  solution  is  to  be  exactly  as  ordered. 
The  spraying  is  done  with  a  special  atomizer  simply 
by  pressing  the  atomizer  bulb,  after  the  point  of 
the  atomizer  has  been  inserted  in  a  nostril.  The 
pressure  on  the  bulb  is  to  be  slow  and  without 
force.  The  safest  form  of  appliance  to  use  for 
douching  the  nose  is  a  fountain  syringe  bag  or 
irrigator  can  with  tubing  attached 
and  a  nasal  tip  inserted  in  the  free 
end  of  the  tubing.  Also,  there  must 
be  a  clamp  on  the  tubing  to  check 
the  flow  of  liquid  until  it  is  required. 
To  use  this  appliance :  Put  the  solution 
prescribed  by  the  doctor  into  the  bag 
or  can ;  hang  this  about  twelve  inches 
Fi  (not  more)  above  the  head,  bend  the 

Glass  nasal  tip.  latter  over  a  basin,  insert  the  point 
of  the  nasal  tip  in  the  nostril  that 
the  doctor  has  specified,  open  the  mouth,  let  the 
solution  run.  It  will  run  in  one  nostril  and  out 
through  the  other  nostril  and  the  mouth.  The 
chief  precautions  to  be  observed  are:  (i)  not  to 
have  the  reservoir  higher  than  stated  above,  not 
to  cough,  sneeze,  swallow,  or  talk  while  the  liquid 
is  running  through.  If  necessary  to  do  any  of  these 
things,  shut  off  the  flow,  for  the  three  first  men- 
tioned may  force  fluid,  etc.,  into  the  Eustachian 
tubes  and  the  other  two  draw  the  tissue  away 
from  the  openings  of  the  tubes  and  thus  facilitate 
the  entrance  of  solution  and  infective  matter  into 
them. 


Medication  149 

Painting  the  membrane  lining  the  nose  is  usually 
done  by  wrapping  a  small  piece  of  absorbent  cotton 
around  a  wooden  toothpick,  dipping  this  in  the 
solution  or  ointment  and  rubbing  it  gently  over 
the  affected  part. 

Local  applications  are  made  to  the  throat  in  the 
same  way  as  to  the  nose  and,  in  addition,  by 
gargling. 

Less  danger  attends  the  use  of  sprays  in  the 
throat  than  in  the  nose,  but  too  much  force  should 
not  be  used  as  it  is  possible  to  drive  infective 
material  into  the  Eustachian  tubes. 

The  chief  points  to  remember  when  painting 
the  throat  are:  (i)  that  the  back  of  the  tongue 
must  be  held  down  so  as  to  afford  a  good  view  of 
the  tonsils  and  surrounding  parts;  (2)  as  a  rule  it 
is  only  the  most  inflamed  parts  that  are  to  be 
painted  and,  as  the  drugs  generally  used  for  such 
purpose  are  very  irritating,  care  should  be  taken 
not  to  include  unnecessary  parts  in  the  applica- 
tion ;  be  careful  not  to  touch  the  back  of  the  throat 
with  the  tongue  depressor  and  only  if  necessary 
with  the  applicator,  because  this  causes  gagging 
and  even  vomiting ;  (3)  never  dip  a  used  applicator 
into  the  solution ;  (4)  do  not  touch  the  point  of  the 
applicator  that  has  been  in  the  mouth,  roll  the 
applicator  in  paper  and  have  it  burned  as  soon  as 
possible  for  inflammatory  conditions  of  the  throat 
are  often  caused  by  germs  that  are  very  easily 
transmitted  to  others  and  cause  very  serious  ill- 
nesses. 


150  Nursing  Methods 

Inhalations  intended  to  produce  external  local 
effects  usually  consist  of  steam  either  alone  or 
with  the  vapor  of  certain  volatile  drugs  that  are 
added  to  the  boiling  water  and  vaporize  with  the 
steam.  The  purposes  for  which  such  inhalations 
are  commonly  used  are:  To  relax  spasmodic  con- 
tractions of  the  muscles  of  the  throat,  such  as  occur 
in  croup,  and  to  soothe  irritated  membrane  and 
congestion  of  the  throat.  The  first  mentioned 
result  is  effected  chiefly  by  heat  and  the  other  two 
both  by  heat  and  the  drugs  used.  Drugs  are  also 
given  by  inhalation  to  produce  effects  after  absorp- 
tion either  upon  distant  or  local  parts.  Examples 
of  those  affecting  distant  parts  are  the  anaesthetics 
such  as  chloroform  and  ether. 

Steam  inhalations  may  be  given  either  with  the 
apparatus  so  arranged  that  the  exit  for  the  steam 
is  in  as  close  proximity  to  the  patient's  mouth  as 
the  heat  of  the  steam  will  permit  or  a  large  kettle 
may  be  used  and  placed  at  a  slight  distance  and  a 
so-called  canopy  or  tent  so  arranged  that  the 
steam  is  directed  toward  the  patient  in  a  manner 
that  will  allow  of  its  being  inspired. 

There  are  a  number  of  appliances  sold  for  giving 
steam  by  close  inhalations — most  of  them  contain 
alcohol  lamps  for  keeping  the  water  boiling  and 
are  thus  dangerous.  What  is  known  as  the  Maw's 
inhaler  has  no  stove  but  is  so  made  that  it  re- 
tains heat  for  a  considerable  length  of  time 
and  is  thus  one  of  the  best  varieties  to  use.  A 
pitcher  is  usually  used  in  emergency  but  it  does 


Medication 


not  retain  the  heat  as  long  nor  does  the  steam 
rise  as  well. 

To  get  the  best  effects  when  a  canopy  is  used  it  is 
well  to  have  an  inhalation  kettle  which  has  a  long 
spout  and  a  small  opening  in 
the  cover  through  which  air 
enters  and  forces   the  vapor 
through  the  spout.     If  an  or- 
dinary kettle  is  used,  the  cover 
must  be  raised  at  one  comer 
for  the  same  purpose  as  this 
opening.    An  electric  stove  is 
the  safest  variety  to  use  and, 
next  to  this,   a  gas  one.     If 
obliged  to  use  an  alcohol  stove 
— place  it   in  a  deep  basin.   Fig. 32.    Maw's  inhaler. 
When  the  canopy  is  arranged 
as  in  Fig.  33,  only  an  electric  stove  should  be  used 
as  the  canopy  comes  in  too  close  contact  for  any 
other  variety  to  be  safe. 

The  foundations  of  the  canopies  shown  in  Figs. 
34  and  35  consist  of  frames  that  are  attached  to 
the  bed,  and  that  in  Fig.  33  is  an  ordinary  bed- 
cradle,  but  a  screen  can  be  used  as  a  foundation 
for  canopies  arranged  as  Figs.  34  and  35,  and  a 
wooden  box  such  as  canned  goods  and  other 
grocery  supplies  are  bought  in  will  answer  as  a 
substitute  for  the  cradle.  The  canopy  consists  of 
a  piece  of  old  blanket  pinned  over  the  top  of  the 
frame  (this  is  to  absorb  moisture  which  otherwise 
may  condense  and  drop  on  the  patient  and  bed- 


152 


Nursing  Methods 


clothes)  and  sheets.  In  Fig.  34  the  sheets  are 
pinned  together  in  the  center  and  then  each  sheet 
is  folded  back  upon  itself  so  that  there  is  a  seam 
in  the  center  between  which  the  spout  of  the  kettle 


Fig-  34-    A.  canopy  arranged  for  steam  inhalation. 

is  fitted  and  the  steam  thus  enters  at  the  back 
above  the  patient's  head.  In  Fig.  35  one  sheet  is 
folded  and  pinned  over  the  top  of  the  frame  and 
the  other  is  pinned  to  this  around  the  back  and 
sides.  The  only  essential  difference  in  the  two 
being  that  in  the  former,  owing  to  the  seam  in  the 
back,  it  is  possible  to  let  the  steam  enter  from  the 
back.  When  a  cradle  is  used,  as  in  Fig.  33,  it  is 
well  to  put  a  rubber  between  the  blanket  and  sheet, 
otherwise,  the  kettle  being  so  near  the  canopy, 
much  of  the  steam  escapes.  The  rubber  and, 
perhaps,  the  blanket,  will  not  be  needed  if  the  box 


Medication 


is  used,  but  if  the  steam  condenses  and  drops  as  it 
probably  will  be  if  the  inhalation  is  continued  for 
any  length  of  time  a  folded  piece  of  old  blanket  can 
be  tacked  inside  the  box.  The  box  should  have  a 


Fig.  J5.    A  canopy  arranged  for  steam  inhalation. 

depth  of  about  twenty-four  inches  and  one  end  has 
to  be  removed.  In  arranging  the  sheet,  which 
should  be  doubled,  leave  a  fold  in  front  so  that  it 
can  be  drawn  down  over  the  patient's  face  from 
time  to  time,  if  desired,  and  thus  the  patient  will 
get  more  vapor. 

Some  important  points  to  remember  when  using 
steam  inhalations  are :  i .  They  will  probably  do 
more  harm  than  good  unless  the  patient  remains  in 
bed,  or  at  least  in  one  room,  during  the  entire  time 
that  the  treatment  is  used. 


154  Nursing  Methods 

2.  The  volatile  drugs  used  for  such  purpose  are, 
almost  without  exception,  inflammable,  and  thus 
the  bottle  containing  the  drug  used  should  not  be 
brought  near  the  flame. 

3.  The  stove  is  to  be  placed  where  there  is  no 
danger  of  the  bedcovers  coming  in  contact  with  it 
or  else  a  guard  must  be  placed  around  it,  e.  g.,  it  can 
be  placed  in  foot- tub  or  deep  granite  basin. 

4.  The  spout  of  the  kettle  must  not  project 
far  enough  under  the  canopy  for  it  to  come  in  con- 
tact with  the  patient. 

5.  A  small  child  should  not  be  left  alone  while 
receiving  such  treatment,  for  it  may  easily  upset 
the  kettle  or  otherwise  burn  itself. 

Demonstration  15 
Application  of  Medication  to  the  Throat 

Requisites  for  painting  or  swabbing  the  throat: 

I.  Tongue  depressors.  Small  strips  of  wood, 
made  for  the  purpose,  can  be  bought  at  any  drug 
store  and  are  the  best  things  to  use  for  this  purpose. 
In  emergency,  however,  the  handle  of  a  spoon  can 
be  used.1 

2.  Applicators,  the  best  kind,  consist  of  a 
slender  strip  of  wood  with  a  piece  of  absorbent 
cotton,  about  one  inch  wide  and  two  to  two  and  a 
half  inches  long  wound  around  one  end.  The 

1  If  a  spoon  is  used  it  must  be  boiled  after  use.  The  wooden 
strips  are  burned. 


Medication  155 

cotton  should  be  left  loose  at  the  point  and  wound 
very  tightly  at  its  upper  end  so  that  it  will  not  fall 
off.  Strips  of  wood  intended  for  this  purpose  can 
be  bought  at  most  drug  stores,  but,  in  emergency, 
the  cotton  can  be  wound  around  a  pencil  or  pen- 
holder. x 

3.  A  paper  bag  or  folded  paper  into  which 
the  depressor  and  applicators  can  be  put  after 
use. 

4.  The  drug,  a  small  bottle  with  water  can  be 
used  for  class. 

5.  A  small  glass. 

Requisites    for    spraying    the    throat:  i.    An 

atomizer. 

2 .    A  handkerchief . 

Requisites  for  giving  inhalations :  I .  A  Maw's 
inhaler  and  a  piece  of  flannel  or  old  blanket  or  a 
bath  towel. 

2.  A  foundation  for  a  canopy,  see  page  152. 

3.  Two  sheets  and  a  piece  of  old  blanket. 

4.  A  paper  of  pins. 

5.  A  kettle. 

6.  A  stove. 

7.  A  stand  for  the  stove  and,  if  necessary,  some- 
thing to  protect  this  from  the  heat. 

1  After  an  applicator  has  been  used  it  must  not  be  dipped  into 
the  solution.  If  more  solution  is  needed,  take  a  fresh  applicator 
or,  if  a  pencil  or  penholder  has  been  used,  wind  fresh  cotton  around 
it.  When  removing  the  cotton,  do  not  touch  it  with  your  fingers, 
to  avoid  doing  so  you  can  cover  it  with  paper. 


156  Nursing  Methods 

Procedure  when  painting  or  swabbing  the 
throat1:  Wash  your  hands.  Arrange  the  applica- 
tors as  directed  on  page  154.  See  that  the  subject 
is  where  the  light  will  fall  into  her  throat.  Pour  a 
small  amount  of  the  liquid  to  be  used  into  the  glass. 

Place  this  where  you  can  reach  it  easily. 

Depress  the  tongue  by  placing  the  point  of  the 
depressor  upon  the  highest  part  of  the  curve  of  the 
tongue  (which  hides  the  part  of  the  throat  that 
is  usually  most  affected)  and  press  it  downward. 
Do  not  let  the  depressor  touch  the  back  of  the 
throat. 

Dip  the  cotton  of  the  applicator  into  the  solution. 

Swab  the  affected  parts  of  the  throat  with  this. 

Procedure  when  spraying  the  throat:  Place  the 
subject2  where  the  light  will  shine  into  her  throat. 

Place  the  handkerchief  where  she  can  reach  it. 

Depress  her  tongue  as  described  in  the  preceding 
section,  but  it  can  be  done  with  the  stem  of  the 
atomizer,  press  the  bulb  and  be  sure  that  the  solu- 
tion reaches  all  congested  parts. 

Procedure  when  arranging  steam  inhalations 
with  a  Maw's  inhaler :  Heat  the  utensil  by  pouring 
water  into  and  over  it. 

1  The  procedure  for  nasal  treatments  will  not  be  described. 
They,  were  mentioned  merely  to  tell  the  pupils  of  the  dangers 
attending  their  use.  This  seemed  advisable,  because  they  are  so 
commonly  used  unnecessarily  and  with  harmful  results.  As  pre- 
viously stated,  they  should  only  be  used  when  prescribed  by  a 
physician  and  his  instructions  should  be  accurately  followed. 

*  The  students  may  act  as  subjects  for  each  other  or  they  may 
stand  in  front  of  mirrors  and  carry  out  these  treatments  on 
themselves. 


Irrigation  157 

Pour  out  this  water  and  then  pour  in  enough 
boiling  water  to  reach  the  level  of  the  opening  of 
the  air  channel  (see  Fig.  33)  and  add  the  drug,  if 
one  has  been  prescribed. 

Insert  the  cork  with  the  mouthpiece  attached 
and  wrap  the  inhaler,  except  the  tip  of  the  mouth- 
piece, in  flannel  or  a  bath  towel. 

If  the  water  is  boiling  when  it  is  used  and  the 
inhaler  is  properly  heated  before  the  water  is  put 
into  it,  vapor  will  continue  to  arise  for  at  least 
twenty  minutes. 

Procedure  when  arranging  for  steam  inhalations 
with  a  canopy :  Secure  the  foundation  in  place  and 
cover  the  top  of  this  with  a  piece  of  old  blanket. 

Drape  the  sheets  around  the  foundation  and  pin 
them  in  place.  The  manner  of  doing  this  will 
depend  upon  the  foundation.  The  way  in  which  it 
has  been  done  in  the  accompanying  illustration 
has  been  already  described.  If  screens  are  used 
the  sheet  around  the  back  and  sides  should  be 
pinned  on  the  inside  so  as  to  protect  the  screen. 

Put  the  stove  in  place.  If  necessary  protect  the 
stand. 

Fill  the  kettle  to  about  three  fourths  its  capacity 
with  boiling  water,  add  the  drug,  if  one  has  been 
prescribed,  and  put  this  on  the  stove. 

Irrigation  of  the  Ear 

Earache  is  a  trouble  for  which  home  remedies 
are  often  used  and,  if  they  are  successful,  no  medi- 


158  Nursing  Methods 

cal  advice  is  sought.  To  show  the  error  of  this 
and  of  the  danger  of  ill-advised  treatment  a  few 
words  will  be  said  here  regarding  the  anatomy  of 
the  ear  and  the  physiology  of  hearing. 

The  ear  consists  of  three  distinct  parts  termed 
the  outer  ear,  middle  ear,  and  inner  ear. 

The  outer  ear  consists  of  the  auricle  (the  part 
outside  the  head)  and  the  auditory  canal.     The 

latter  in  the  adult 
is  about  i}4  inches 
long  and  is  curved 
so  that  its  central 
portion  is  higher 
than  the  opening 
or  terminal.  The 
outer  portion  of  the 
canal  is  of  cartilage, 
the  remainder  is 
hollowed  out  of  the 
temporal  bone.  In 
small  children  the 
bone  is  less  formed 
and  the  canal  is 

Fig.  36.     Vertical  section  through  the  straight.     This  dif- 

external  auditory  meatus  and  tympanum,  f  erence  {n  ^  gh 
passing  in  front  of  the  fenestra  ovabs. 

Note  shape  of  auditory  canal.  of   the  canal  must 

be  remembered 

when  irrigating  the  ear.  The  canal  is  lined  with  a 
membrane  in  which  there  are  cells  that  secrete  a 
sticky  substance,  known  as  cerumen  or  wax,  which 
is  intended  to  keep  foreign  substances  from  enter- 


Irrigation  159 

ing  the  ear.  Normally,  only  a  small  amount  of 
cerumen  is  secreted,  but,  if  the  canal  is  irritated, 
the  cells  may  become  overactive  and  secrete  so 
abundantly  that  hard  masses  of  wax  are  deposited. 

The  middle  ear  is  a  cavity  hollowed  out  of  the 
temporal  bone.  It  is  divided  from  the  canal  of 
the  outer  ear  by  a  very  thin  membrane,  known  as 
the  tympanum  or  drum.  Three  small  bones  called 
because  of  their  shapes,  the  hammer,  anvil,  and 
stirrup  stretch  across  the  cavity.  One  end  of  the 
hammer  is  attached  to  the  drum  and  the  other  to 
the  anvil.  The  free  end  of  the  anvil  is  attached  to 
the  stirrup  and  the  free  end  of  the  latter  to  a  mem- 
brane that  is  stretched  across  one  of  the  two  open- 
ings that  lead  into  the  inner  ear.  In  the  back  part 
of  the  middle  ear  there  is  a  minute  passage  into  the 
part  of  the  temporal  bone  known  as  the  mastoid, 
and  there  is  also  a  canal  leading  into  the  throat. 
This  is  known  as  the  Eustachian  tube  and  its  pur- 
pose is  to  equalize  the  air  pressure  on  both  sides  of 
the  drum. 

The  inner  ear  consists  of  three  cavities,  known 
as  the  vestibule,  the  cochlea  or  snail  shell,  and  the 
semi-circular  canals.  In  each  of  these  cavities 
there  is  a  membranous  bag,  and  the  spaces  between 
the  bone  and  bags  and  within  the  bags  contain 
fluid.  That  surrounding  the  bags  is  known  as 
perilymph,  and  that  within  the  bags  as  endolymph. 
The  fibers  constituting  a  portion  of  the  membrane 
within  the  cochlea  are  connected  with  processes  of 
the  auditory  nerve,  this  is  also  the  case  with  the 


160  Nursing  Methods 

membrane  in  the  semicircular  canal,  but  the  nerve 
fibers  extending  from  this  portion  of  the  ear  only 
go  for  a  short  distance  into  the  brain  with  the 
fibers  from  the  cochlea  and  then  they  branch  off 
and  connect  with  portions  of  the  brain  that  help  to 
control  the  coordination  of  certain  muscles.  Thus 
the  semicircular  canals  are  not  concerned  with 
hearing,  but  with  maintaining  balance. 

Sound  consists  of  wave-like  vibrations  in  matter 
(usually  the  air)1  that  affect  the  auditory  nerve. 
When  the  waves  enter  the  ear  they  make  the  drum 
membrane  vibrate  in  like  manner,  this  induces 
similar  vibrations  in  the  small  bones  of  the  middle 
ear  and,  in  turn,  the  lymph  and  membrane  of  the 
inner  ear.  It  is  thought  that  the  fibers  of  the  mem- 
brane in  the  cochlea  that  are  connected  with  the 
auditory  nerve  are  held  at  different  tensions  and 
are  thus  affected  by  waves  with  different  rhythms 
(just  as,  if  the  cover  of  a  piano  is  left  open  and  a 
note  struck  on  another  musical  instrument  in  the 
room  the  same  string  in  the  piano  will  vibrate),  and 
that  the  interpretation  in  the  brain  depends  at 
least  partly  upon  the  nerve  fibers  over  which  the 
impulses  come.3 

'Sound  is  transmitted  through  liquid  and  solid  matter  even 
more  readily  than  through  air,  for  example,  the  vibrations  pro- 
duced in  water  by  the  paddle  wheel  of  a  steamer  can  be  heard  a 
mile  away  if  the  ear  is  held  near  the  water. 

2  It  is  to  be  realized  that  we  do  not  actually  hear  with  our  ears 
or  see  with  our  eyes  or  feel  at  the  exterior  of  the  body.  These 
parts  being  merely  the  portion  of  the  various  mechanisms  that 
receive  and  transmit  the  external  stimulus  to  the  brain. 


Irrigation  161 

The  most  common  abnormal  conditions  of  the 
ear  and  their  causes  are : 

1.  The  collection  of  wax  in  the  auditory  canal. 

2.  The  formation  of  pimples  or  boils  in  the 
canal. 

The  most  common  cause  of  both  of  these  condi- 
tions is  irritation  of  the  canal  in  the  endeavor  to 
clean  it  with  pins  and  the  like  and  by  putting  irri- 
tating liquids  into  it  in  the  treatment  of  earache. 
It  is  usually  unnecessary  to  clean  the  ear  further 
than  the  tip  of  the  small  ringer  can  reach  and,  if 
so  much  wax  is  being  secreted  that  further  means 
are  necessary,  a  doctor  should  be  consulted.  The 
tip  of  the  finger  should  be  covered  with  a  clean, 
soft  cloth  before  being  put  into  the  canal. 

3.  Blocking  of  the  Eustachian  tubes.    This  is 
usually  the  result  of  inflammation  in  the  throat, 
or  enlarged  tonsils,  or  the  presence  of  adenoids. 
It  interferes  with  the  passage  of  air  into  and  out  of 
the  tubes  and,  therefore,  the  air  pressure  on  the  two 
sides  of  the  drum  becomes  unequal  and  the  normal 
vibration  of  the  latter  is  interfered  with.     This 
interferes  with  hearing  and  it  is  likely  to  cause 
ringing  and  buzzing  sensations,  because  the  audi- 
tory nerve  endings  are  stimulated. 

4.  Inflammation  of  the  middle  ear.     This  is 
usually  due  either  to  the  extension  of  inflammation 
from  the  throat  (e.g.,  tonsillitis)  or  to  forcing  virus 
from  an  inflamed  throat  or  nose  into  a  tube  by 
improper  irrigation  or  spraving  of  the  nose  or 
throat. 


1 62  Nursing  Methods 

Thus  it  can  be  appreciated  that  earache  is  not  a 
condition  to  be  left  to  home  treatment.  If  it  occurs 
when  it  is  not  convenient  to  consult  a  doctor,  as  at 
night,  heat  can  be  sometimes  applied  in  the  form 
of  a  hot-water  bag  or  an  irrigation,  as  described 
later,  but,  even  if  the  pain  ceases,  the  doctor  should 
be  consulted  as  soon  as  possible  so  that  the  cause 
of  the  earache  can  be  found  and  removed. 

If,  however,  the  pain  is  behind  the  ear,  heat 
should  not  be  used  without  first  consulting  a  doctor, 
even  if  it  is  at  night,  especially  if  the  sufferer  is  a 
child,  because  pain  behind  the  ear  is  often  due  to  a 
dangerous  condition  known  as  mastoiditis. 


Demonstration  16 
Irrigation  of  the  Ear 

Equipment :  I .  A  fountain  syringe  bag  or  other 
type  of  irrigator  with  a  clamp  on  its  tubing  and,  if 
possible,  a  return  flow  aural  nozzle1  in  its  free  end; 
a  piece  of  rubber  tubing  between  twelve  and  four- 
teen inches  long  on  the  side  projection  of  the 

1  Fig-  37  shows  a  return  flow  aural  nozzle.  The  dotted  line 
indicates  a  small  tube  inside  the  nozzle  through  which  the  water 
flows  from  the  reservoir  into  the  ear.  As  can  be  seen  in  the  illus- 
tration, there  is  room  for  the  water  flowing  from  the  ear  to  re- 
enter  the  nozzle  around  this  tube  and  it  flows  from  the  nozzle 
through  the  side  projection.  This  is  about  the  best  appliance  to 
use  for  irrigation  of  the  ear  because,  if  the  reservoir  is  not  raised 
more  than  about  twelve  inches  the  water  will  flow  in  and  out  of  the 
ear  without  making  any  pressure  on  the  drum. 


Irrigation  163 

nozzle.    About  one  quart  of  water  with  a  tempera- 
ture between  106°  and  110°  F.  in  the  reservoir. 
2.     A  rubber 


par  hnlh1  and  a  _  ,-„_  TIP  FOH  ATTACHMENT 

^^O^JO  TUBING  COHHICTO> 

basin  contain- 
ing  water  with 
the  tempera- 
ture mentioned 

above.  f>oiNTron 

.          ,,  INSERTION  IN  CAR 

3.  A     ther- 
mometer   to 

,      ,  ,  ,  TIP  FOR  CONNECTION  WITH 

take    the    tem-  TUBING  FOR  RETURN  now 

perature  Of  the         pig.  37.     Glass  return-flow  ear  nozzle. 

water. 

4.  A   basin    with    a    capacity   of    about    one 
quart. 

5.  A  bath  towel  and  pin. 

6.  Pledgets  of  absorbent  cotton  made  by  taking 
pieces  of  cotton  about  1^2  inches  square  and  twist- 
ing one  end  of  each  piece  into  a  point  that  will  allow 
of  its  ready  insertion  in  the  ear;  the  twist  must  not 
be  very  tight  or  the  power  of  the  cotton  to  absorb 
the  moisture  from  the  ear  will  be  lessened.     If 
cotton  cannot  be  obtained  pieces  of  soft,  clean 
muslin  can  be  used  but,  as  they  will  not  remain 


1  Rubber  bulb  ear  syringes  are  cheaper  than  the  above  appara- 
tus and  are  therefore  more  commonly  used,  but  they  do  not  allow 
of  the  steady,  constant  flow  of  water  provided  by  the  other 
appliance  and,  unless  care  is  taken  not  to  squeeze  a  bulb  quickly 
or  forcibly,  enough  pressure  will  be  made  on  the  drum  to  cause 
pain. 


1 64 


Nursing  Methods 


twisted,  they  are  only  prepared  when  needed.  On 
no  account  should  any  hard  pointed  implement 
be  put  into  the  ear  by  anyone  but  a  doctor. 

7.  A  receptacle  for  used  pled- 
gets. 

Procedure  when  a  return  flow 
nozzle  is  used:  Hang  the  reser- 
voir about  twelve  inches  above  the 
patient's  ear. 

Have  her  lie  or  sit  with  the 
affected  ear  uppermost. 

Put  the  towel  around  her  neck 
and,  unless  she  is  lying  down, 
pin  it. 

Hold  the  nozzle  over  the  basin, 
open  the  clamp  on  the  tubing 
and  let  enough  water  run  through 
the  tubing  to  heat  it  and  expel  the  air.  Check  the 
flow  and  place  the  basin  the  same  distance  below 
the  ear  that  the  reservoir  is  above  it.  Put  the  free 
end  of  the  tubing  for  the  return  flow  into  the  basin. 
Insert  the  tip  of  the  nozzle  in  the  auditory  canal 
and  let  the  water  flow.  While  it  is  doing  so  pull 
the  auricle  of  the  ear  backward  and,  if  the  patient 
is  an  adult,  upward  (the  reason  for  this  was  men- 
tioned on  page  158). 

If  pain  or  dizziness  are  occasioned,  lower  the 
reservoir  as  these  sensations  are  usually  occasioned 
by  too  much  pressure  on  the  drum. 

Shut  off  the  current  before  the  solution  reaches 
the  lower  exit  of  the  irrigator. 


Fig.  38.     Rubber 
ear  syringe. 


Conjunct 


Fig.  39.     Diagram  of  the  right  eye  in  horizontal  section,  showing  the  upper 
surface  of  the  lower  segment. 


Irrigation  165 

Remove  the  basin,  etc.,  and,  if  necessary,  dry 
the  neck  and  around  the  ear. 

Insert  the  pointed  edge  of  a  pledget  in  the  ear, 
while  doing  this  hold  the  auricle  in  the  manner  just 
described  so  as  to  straighten  the  canal. 

Change  the  pledget  after  a  few  minutes  and 
continue  doing  this  until  the  pledget  removed  is 
dry.  Do  not  rub  the  walls  of  the  canal. 

If  the  irrigator  is  used  without  a  nozzle  make  the 
following  differences  in  the  procedure:  Hold  the 
basin  for  the  return  flow  pressed  tightly  against 
the  neck  under  the  ear  being  treated.  Put  the  free 
end  of  the  tubing  at,  but  not  actually  in,  the  orifice 
of  the  canal;  that  is,  space  enough  must  be  left  for 
the  exit  of  the  water. 

When  a  bulb  syringe  is  substituted  for  the  irri- 
gator, fill  it  by  holding  its  tip  in  the  water  and 
pressing  the  bulb.  To  use  it  hold  the  point  at,  but 
not  in,  the  opening  of  the  auditory  canal  and  press 
the  bulb  gently  and  slowly.  Otherwise,  the  proce- 
dure is  the  same  as  when  an  irrigator  is  used. 

Application  of  Medicine  to  the  Eyes 

There  is,  probably,  no  part  of  the  body  more 
easily  injured  than  the  eyes  and  no  attempt  should 
be  made  to  treat  abnormal  conditions  of  these 
organs  without  first  consulting  an  oculist.1 

Two  particularly  important  reasons  for  this  are : 

1 A  physician  who  specializes  in  the  treatment  of  diseases  of  the 
eyes. 


1 66 


Nursing  Methods 


(i)  Redness  of  the  lids,  styes  and  the  like,  which 
people  are  so  prone  to  treat  according  to  the  advice 
of  their  friends,  are  very  often  the  result  of  eye- 
strain,  i.e.,  of  forcing  certain  small,  and  exceed- 
ingly delicate,  muscles  within  the  eyeballs  to  do 
more  work  than  they  are  fitted  to  perform.  Their 
work  is  to  so  adjust  a  part  of  the  eyeball,  known 
as  the  lens,  that  the  light  rays  entering  the  pupil1 
from  different  angles  are  brought  to  a  focus  on  a 
certain  part  of  the  inner  wall  or  retina2  of  the  eye- 
ball. When  we  are  looking  at  things  in  the  distance 

these  muscles  are 
at  rest,  but,  when 
we  look  at  any- 
thing near  at 
hand,  the  muscles 
contract  and  this 
makes  the  lens3 
become  more  con- 
vex and  the  rays 
of  light  are  then 
brought  to  a  focus 
sooner  than  they 
otherwise  would  be.  Quite  a  number  of  ab- 
normal conditions  may  exist  in  the  eyeball  that 

1  The  hole  in  the  iris,  which  is  the  colored  portion  in  the  front 
wall  of  the  eyeball. 

2  The  retina  consists  chiefly  of  a  portion  of  the  optic  (sight)  nerve. 

3  The  lens  is  a  transparent  jelly-like  body  that  is  surrounded  by 
a  thin  transparent  membrane.    The  latter  is  attached  at  either 
side  of  the  eyeball  to  the  ciliary  muscles  and  is  held  suspended 
behind  the  iris  and  pupil  and  in  front  of  the  retina. 


Fig.  40. 


Muscles  that  move  the  eyeball. 
(Gerrish.) 


Irrigation  167 

will  make  it  harder  for  these  muscles  to  do  their 
work  effectually  or  the  defect  may  be  in  the  muscles 
themselves.  In  either  case,  the  muscles  are  likely 
to  be  injured  if  they  are  not  helped  by  the  use  of 
glasses  that  will  give  the  required  aid  in  refracting 
(bending)  the  rays  of  light  entering  the  pupil. 
The  local  irritation  arising  when  these  muscles 
are  undergoing  strain,  for  reasons  given  on  page 
80,  may  induce  congestion  and  consequent  ab- 
normal conditions  of  the  eyes  and  lids.  It  can  be 
appreciated  from  what  has  been  said,  that  treat- 
ment which  temporarily  relieves  congestion  and 
its  external  results,  but  not  the  conditions  pro- 
moting the  strain,  are  not  to  be  relied  upon. 

2.  The  other  particularly  important  reason  for 
consulting  an  oculist  if  the  eyes  become  at  all  in- 
flamed is  that  they  are  subject  to  infection  by  a 
number  of  organisms  that  may  speedily  cause 
severe  inflammations  and  even  blindness. 

The  treatment  of  the  more  serious  inflammations 
requires  an  expert  and  those  described  here  are 
only  such  as  are  frequently  prescribed  for  simple 
congestions  and  the  like,  such  as  are  promoted  by 
eyestrain;  they  should,  however,  only  be  carried 
out  upon  the  advice  of  a  doctor. 

Demonstration  17 
Irrigating  and  Putting  Medicine  in  the  Eyes 

Articles  required  for  an  irrigation:  i.  A  small 
clean  basin  containing  about  one  half  to  one  pint  of 


168  Nursing  Methods 

whatever  solution  is  ordered  (warm  water — about 
100  F. — will  answer  for  class)  and  some  pledgets1 
of  absorbent  cotton. 

2.  Dry  absorbent  cotton  pledgets.1 

3.  A  towel  and  safety  pin. 

4.  An  empty  basin. 

5.  A  receptacle  for  used  pledgets. 

Articles  required  when  an  eye-bath  is  used  for 
cleansing  or  the  application  of  medication:  (i) 
an  eye-bath,  about  three  quarters  full  of  the  solu- 
tion prescribed  (the  eye-bath  is  a  small  oval  cup 
that  fits  around  the  eye). 

(2)  A  towel  and  pin. 

Articles  required  for  putting  drops  of  medicine 
in  the  eyes :  i .  The  drug  that  is  to  be  used  (for 
class  clean  warm  water  in  a  small  bottle). 

2.     A  medicine  dropper. 

Important  precautions  to  be  taken  when  giving 
these  treatments  are :  (i)  Do  not  let  the  tip  of  the 
medicine  dropper  come  in  contact  with  the  eye; 
(2)  avoid  making  pressure  upon  the  eyeball  when 
separating  the  eyelids ;  (3)  when  irrigating  the  eye, 
direct  the  current  toward  the  outer  angle  of  the 
eye  and  away  from  the  nose,  because  there  is  a 
small  duct  leading  from  the  eye  into  the  nose2  and 


1  Pieces  of  cotton  about  an  inch  or  an  inch  and  a  half  square. 

3  This  duct  is  intended  as  a  passageway  for  the  tears  which  are 
being  constantly  secreted  by  glands  at  the  upper  and  outer  angles 
of  each  eye.  These  tears  are  intended  to  keep  the  surface  of  the 
eye  moist.  Unless  they  are  secreted  in  unusual  amount  (as  when 
the  person  is  crying)  their  presence  is  not  marked,  for  their  evapo- 


Irrigation  169 

if  any  foreign  substance  is  washed  into  it  serious 
trouble  may  result ;  (4)  do  not  use  anything  rough, 
as  gauze,  for  wiping  the  eye — absorbent  cotton  is 
particularly  good  for  the  purpose;  (5)  be  careful 
to  have  the  solution  the  strength  and  temperature 
prescribed  by  the  physician. 

Procedure  when  irrigating  an  eye:  Pin  the 
towel  around  the  patient's  neck. 

Scrub  your  hands. 

Have  the  patient  sit  or  lie  with  the  head  thrown 
back  and  so  tilted  that  the  eye  to  be  treated  is 
slightly  lower  than  the  other  (in  order  to  avoid 
washing  discharge  into  the  well  eye)  and  place  or 
have  patient  hold  the  empty  basin  where  the  solu- 
tion will  flow  into  it. 

Wash  any  adherent  discharge  from  the  lids  with 
pledgets  moistened  with  solution.  Do  not  put  a 
used  pledget  back  into  the  solution. 

Separate  the  lids  by  making  traction  upon  the 
flesh  above  and  below  the  lids  with  the  thumb  and 
first  finger  of  your  left  hand,1  making  all  necessary 
pressure  upon  the  lower  ridge  of  the  forehead  and 
upper  part  of  the  cheek  bone,  never  on  the  eyeball. 

Squeeze  the  solution  over  the  eye  from  the 
pledgets  in  such  a  manner  that  it  will  be  directed 
away  from  the  inner  angle  of  the  eye.  During  the 
treatment  have  the  patient  look  upward  and  down- 
ward, making  the  change  by  moving  the  eyeball, 

ration  or  passage  into  the  ducts  leading  into  the  nose  keeps  pace 
with  the  rate  of  secretion. 

1  Each  pupil  should  practice  doing  this  on  herself. 


170 


Nursing  Methods 


not  the  head,  so  that  as  much  of  the  eyeball  at 
possible  will  be  subjected  to  the  irrigation. 

At  the  conclu- 
sion of  the  treat- 
ment dry  the  eye 
by  gently  patting 
around  it  with  a 
//  pledget  and  dry 
the  face  with  the 
towel. 

P  r  ocedur  e 
when  using  an 
eye-bath:  Pin  the 

Fig.  41.  Drawing  the  eyelids  apart  by  towel  around  the 
making  traction  on  the  flesh  above  and  below  ^O4.'or,f'c  „  0~i, 

.j  ,.  .,    T)  a  L  i  e  n  L  s   necjx. 

the  eye,  exerting  necessary  pressure  on  the      . 

bones  of  the  forehead  and  cheek.  give  her  the   CUp 

and  instruct  her 

to  (i)  bend  her  head  forward  and  press  the 
cup  firmly  around  the  eye,  keeping  the  eye 
closed  while  doing  so,  and  (2)  (pressing  the  cup 
in  place)  to  throw  her  head  backward  and,  for  the 
length  of  time  prescribed,  which  is  usually  two  to 
five  minutes,  to  keep  alternately  opening  and 
closing  her  eye  and  moving  the  eyeball;  (3)  to 
bend  her  head  forward  and  remove  the  glass. 

Procedure  in  dropping  medicine  in  the  eye: 
Place  the  patient  with  her  head  tilted  slightly  back- 
ward ;  take  up  as  much  of  the  drug  in  the  dropper 
as  required,  but  leave  the  latter  in  the  bottle. 
Draw  down  the  lower  eyelid  with  the  first  finger  of 
your  left  hand  and  tell  the  patient  to  look  upward. 


External  Applications          171 

Take  the  dropper  in  your  right  hand  and,  holding  it 
slightly  above,  but  not  touching  the  eye,  make  very 
slight  pressure  on  the  rubber  nipple  of  the  dropper 
so  that  the  number  of  drops  prescribed  will  fall  on 
the  inner  surface  of  the  lid.  Release  the  lid  slowly 
and  tell  the  patient  to  close  her  eye.  When  the 
medicine  is  applied  in  this  way  it  enters  the  eye 
quite  as  well  as  when  it  is  dropped  directly  on  the 
eyeball  and  it  causes  less  irritation. 

Applications  to  the  Skin 

The  purposes  for  which  applications  are  most 
frequently  made  to  the  skin  are :  (i)  To  overcome 
abnormal  conditions  of  the  skin  itself  or  of  the 
tissues  situated  directly  beneath  it;  (2)  to  lessen 
congestion  and  pain  in  the  internal  organs  and  (3) 
to  cause  the  expulsion  of  gas  from  the  stomach 
and  intestines.  Also,  there  are  a  few  drugs  that 
can  be  absorbed  through  the  skin  and  these  are 
sometimes  administered  by  a  process  known  as 
inunction. 

Examples  of  the  uses  of  applications  to  cure 
external  abnormal  conditions  are:  (i)  To  lubri- 
cate or  soften  roughened  skin  or  mucous  mem- 
branes; (2)  to  dry  moist  surfaces,  especially  those 
denuded  of  skin ;  (3)  to  act  as  astringents,  that  is, 
to  cause  contraction  of  tissue  and  thus  lessen  the 
amount  of  blood  in  the  part  and  check  secretion ; 
(4)  to  depress  sensory  nerve  endings  in  the  part  and 
thus  alleviate  local  pain ;  (5)  to  kill  or  render  inert 


Nursing  Methods 

organisms  causing  skin  lesions ;  (6)  to  soften  tissue 
and  increase  the  amount  of  blood  in  an  infected 
part  and  thus  get  a  local  increase  in  the  amount 
of  white  corpuscles  and  other  substances  that  the 
blood  contains  for  fighting  bacteria — heat1  is  the 
agent  most  commonly  employed  for  this  purpose; 
(7)  to  lessen  the  amount  of  blood  in  an  area  and 
thus  relieve  pain  due  to  congestion;2  cold2  and 
drugs,  which  act  as  astringents  described  above,  are 
generally  used  for  this  purpose  and,  when  they  are 
employed,  the  inflamed  part  is  usually  raised  for 
this  favors  the  flow  of  blood  away  from  it  and 
slightly  impedes  the  flow  toward  it. 

The  external  applications  used  to  affect  the 
internal  organs  are:  Irritant  substances  such  as 
mustard,  turpentine,  and  iodine;  heat;  cold.  Irri- 
tant substances  used  to  relieve  pain  are  known  as 
counterirritants  because  they  counter  or  relieve 
pain  already  existing.  Heat  also  induces  irritation 
and  thus  acts  as  a  counterirritant  and,  as  it  induces 
a  particularly  marked  dilation  of  blood-vessels 
and  softens  and  expands  tissue,  it  is  often  a  par- 
ticularly valuable  one.  The  relief  of  pain  and 

1  As  previously  stated,  when  a  part  is  congested  the  local  blood- 
vessels are  dilated  and  distended  with  blood,  this  results  in  an 
increased  exudation  of  lymph  into  the  tissues  of  the  part  and  this 
sometimes  induces  pressure  on  nerve  endings  thereby  causing 
pain. 

1  Heat  or  cold  should  not  be  used  without  a  doctor's  order  for 
these  purposes,  because  heat  tends  to  promote  suppuration  (the 
formation  of  pus)  which  under  some  conditions  may  be  harmful, 
and  cold,  by  forcing  the  blood  away  from  a  part  reduces  the 
amount  of  protective  substances  to  fight  the  bacteria. 


External  Applications         173 

congestion  in  the  internal  organs  by  counterirri- 
tants  and  cold  depends  upon  the  fact  that  nerve 
fibers  extending  from  the  skin  connect  in  the  spinal 
cord  with  fibers  that  transmit  impulses  to  the 
viscera  (internal  organs).  Neither  heat  nor  cold, 
in  degrees  that  can  be  used  on  the  skin,  penetrate 
the  tissues,  but  irritation  on  an  area  of  skin  will 
give  rise  to  nerve  impulses  that  pass  to  the  cord 
and  are  discharged  over  the  connecting  fibers  to 
the  muscle  tissue  in  the  organs  and  blood-vessels 
situated  below  that  area  of  skin.  The  impulses 
contract  the  blood-vessels  and,  thereby,  force 
blood  from  the  area  so  that  congestion  and  pain 
due  to  it  are  lessened  and  when,  for  example,  hot 
fomentations  are  applied  to  the  abdomen  the 
muscle  tissue  in  the  walls  of  the  stomach  and  in- 
testines contracts  and  forces  gas  from  the  organs. 

If  too  severe  irritation  is  produced  by  any  means 
blisters  are  likely  to  form  because  extreme  irrita- 
tion increases  the  amount  of  blood  in  the  irritated 
part  to  such  a  degree  that  there  is  excessive  transu- 
dation  of  fluid  from  the  vessels  and  this  separates 
the  outer  from  the  under  layers  of  skin,  which 
constitutes  a  blister.  Certain  irritants,  especially 
cantharides,  are  used  purposely  to  produce  blisters, 
and,  if  properly  applied,  they  will  do  so  without 
injuring  the  underlying  tissues  but,  when  irritation 
severe  enough  to  cause  blistering  is  produced  by 
the  majority  of  irritants,  lesions  that  are  very  hard 
to  cure  may  be  caused. 

The  medicated  preparations  most  commonly 


174  Nursing  Methods 

used  for  external  applications  are :  Solutions,  lini- 
ments, ointments,  plasters,  pastes,  poultices. 
Articles  commonly  used  for  hot  applications  are: 

Hot-water  bags,  electric  pads,  the  flatiron,  salt, 
fomentations  or  compresses,  poultices;  also,  there 
are  electric  baths  and  ovens  but  these  are  seldom 
available  for  home  use.  Articles  commonly  used 
for  cold  applications  are :  Ice-caps  and  compresses. 

Solutions  are  liquids  containing  dissolved  matter. 
Most  of  those  used  for  external  applications  are 
disinfectants1  and  some  of  them  are  also  astrin- 
gent,2 and  the  so-called  tincture  of  iodine  is  both 
a  disinfectant  and  a  counterirritant. 

Liniments  are  liquid  or  semi-liquid  preparations 
the  majority  of  which  contain  irritant  substances 
in  an  oily  or  alcoholic  medium.  They  are  used 
chiefly  to,  by  counterirritation,  relieve  pain  in 
superficial  tissues. 

Ointments  are  soft  preparations  of  fatty  sub- 
stances in  which,  as  a  rule,  a  drug  is  incorporated. 
Drugs  with  various  actions  are  used  in  this  way 
and  therefore  ointments  are  employed  for  a  num- 
ber of  different  purposes. 

Plasters  are  preparations  of  drugs  combined 
with  a  resinous  substance  that  is  spread  upon  and 
adheres  to  a  foundation  of  muslin  or  similar 
material. 

1  Substances  that  kill  bacteria. 

'Substances  that  cause  the  contraction  of  tissue.  Many  as- 
tringents also  lessen  the  sensitiveness  of  nerve  endings  and  these 
lessen  pain. 


External  Applications         175 

Pastes  are  soft  viscid  substances.  Mustard 
paste  and  mustard  plaster  are  known  as  sinapisms 
from  the  Latin  name  for  mustard,  sinapis. 

Poultices  are  soft,  hot,  moist  pastes.  Anything 
that  can  be  made  into  such  a  paste  and  that  retains 
heat  well  can  be  used  for  the  purpose,  but  flax- 
seed  or,  as  it  is  generally  called,  linseed,  is  usually 
preferred  as  it  is  inexpensive  and  answers  these 
requirements  particularly  well.  Antiphlogistin  or 
clay  poultice,  which  consists  of  kaoline  (a  form  of 
clay),  glycerine,  and  several  drugs  with  mild  coun- 
terirritant  properties,  is  also  considerably  used 
and,  for  small  poultices,  bread. 

Stupes  or  fomentations  consist  of  flannel  or 
compresses  of  gauze  or  other  soft  material  wrung 
out  of  very  hot  water. 

Demonstration  18 

Methods  of  Using :  Iodine,  Liniments,  Ointments, 
Plasters  and  Articles  Employed  for  Hot  and 
Cold  Applications1 

Equipment  for  demonstration : 

A  bottle  of  tincture  of  iodine  and  some  applica- 
tors (matches  with  small  pieces  of  absorbent  cotton 
twisted  around  one  end  can  be  used),  a  receptacle 
for  used  applicators  (a  paper  bag  will  answer  the 
purpose). 

1  Most  of  these  procedures  are  so  simple  that,  if  time  is  limited, 
a  few  questions  regarding  necessary  precautions  and  methods  will 
be  as  valuable  as  a  demonstration. 


1 76  Nursing  Methods 

A  jar  of  ointment,  a  spatula  (a  knife  can  be 
substituted),  compresses  of  gauze  or  soft  muslin, 
a  bandage. 

A  piece  of  a  plaster  such  as  cantharides  or  bella- 
donna, if  it  can  be  obtained,  but  this  is  not  impor- 
tant. 

A  hot-water  bag  and  cover. 

An  electric  pad,  if  one  can  be  obtained  easily. 

A  bag  of  salt,  a  pan,  spoon,  and  stove. 

A  flatiron  and  a  piece  of  flannel  or  flannelet 
about  half  a  yard. 

An  ice-cap  and  cover  (a  piece  of  thin  soft  muslin 
will  answer  the  purpose),  ice  and  appliances  for 
cracking  it. 

Arrange  the  articles  required  for  cold  compresses 
on  a  small  tray,  such  compresses  are  most  com- 
monly used  for  the  eyes  and  on  the  forehead  to 
relieve  headache.  The  articles  required  are:  Two 
small  bowls,  one  enough  smaller  than  the  other 
to  be  inverted  in  it.  A  lump  of  ice  placed  on  top 
of  the  inverted  bowl,  a  little  water  in  the  other 
bowl,  compresses  for  the  eyes  which  should  consist 
of  small  squares,  about  an  inch,  of  absorbent  cotton 
or  folded  pieces  of  soft  muslin.  Compresses  for 
the  forehead,  viz.,  pieces  of  gauze  or  muslin  or  a 
handkerchief  folded  to  fit  the  forehead.  A  recep- 
tacle for  used  compresses,  a  towel. 

Procedure:  The  demonstration  doll  for  the 
patient. 

To  apply  iodine:  Dip  the  covered  end  of  the 
applicator  in  the  iodine  and  then  rub  this  on  the 


External  Applications         17? 

skin,  let  the  application  dry,  if  the  skin  does  not 
become  a  deep  brown  color,  repeat  the  procedure. 
When  it  is  employed  to  produce  counterirritation, 
enough  iodine  must  be  used  to  produce  a  fairly 
deep  brown  color  and  induce  a  slight  stinging  sensa- 
tion that  will  be  felt  for  a  few  minutes,  but  too 
much  must  not  be  used  or  blisters  will  result. 
Other  precautions  necessary  are:  The  skin  must 
not  be  moist  and  thus  iodine  should  not  be  applied 
soon  after  the  part  has  been  washed,  for  moisture 
increases  the  irritant  action  of  the  iodine ;  the  part 
should  be  left  exposed  for  a  time.  If  too  much  irri- 
tation is  induced  the  iodine  can  be  easily  removed 
by  washing  the  part  with  ammonia  water  or  strong 
soapsuds  or  alcohol. 

To  apply  a  liniment:  Place  the  patient  in  a 
comfortable  position ;  pour  a  little  liniment  on  the 
part  (do  not  let  the  rim  of  the  bottle  touch  the 
patient's  skin)  and  rub  the  liniment  into  the  skin, 
exerting  as  much  pressure  as  the  patient  can  toler- 
ate. Continue  to  do  this  for  from  ten  to  twenty 
minutes;  use  more  liniment  if  necessary  to  main- 
tain a  slight  stinging  sensation. 

Ointments  are  applied  in  two  different  ways: 
(i)  They  are  rubbed  into  the  skin;  (2)  they  are 
spread  on  some  soft  material  as  muslin  or  a  gauze 
compress  and  bandaged  over  the  part.  Ointments 
are  applied  in  the  manner  first  mentioned  both  for 
local  effects  and  in  order  that  the  drug  contained 
in  the  preparation  may  be  absorbed.  Especially 
when  the  ointment  is  used  for  the  latter  purpose 


1 78  Nursing  Methods 

it  is  important  that  the  skin  be  first  washed  with 
soap  and  hot  water  and,  if  possible,  alcohol  so  as 
(i)  to  remove  the  sebaceous  matter,  which  is 
always  present  on  the  skin  and  interferes  with 
absorption,  and  (2)  to  make  the  skin  soft  and  red, 
the  redness  is  due  to  an  increased  supply  of  blood 
in  the  part  and  this  favors  absorption.  When 
ointment  is  rubbed  into  the  skin  to  promote  the 
absorption  of  a  drug  the  process  is  known  as 
inunction. 

When  ointments  are  used  on  sores  or  wounds 
the  second  method  of  application  is  generally 
employed  and  the  following  precautions  must  be 
observed :  (i)  The  gauze  or  muslin  must  be  sterile, 
if  there  are  no  sterile  supplies  at  hand  a  piece  of 
clean  muslin  can  be  sterilized  by  passing  a  hot  iron 
over  it  several  times.  (2)  The  ointment  must  be 
taken  from  the  jar  and  spread  with  a  spatula  or  a 
suitable  substitute  as  a  knife  and  this  should  be 
boiled  before  use.  (3)  Enough  ointment  must  be 
used  to  prevent  the  dressing  sticking  to  the  sore 
or  wound. 

Plasters,  with  the  exception  of  sinapisms,  are 
usually  prepared  for  use  by  warming  them,  which 
softens  the  resinous  substance ;  this  can  be  done  by 
putting  it  in  a  warm  oven  for  a  few  minutes  or 
under  the  lighted  jets  of  a  gas  stove ;  the  skin  should 
be  prepared  in  the  same  manner  as  for  an  inunction 
and  it  should  be  warm  when  the  plaster  is  applied. 
The  latter  is  laid  on  the  skin  and  pressed  slightly 
with  the  hand  which  makes  it  adhere  to  the  skin. 


External  Applications         179 

If  necessary  it  is  covered  with  a  bandage.  The 
method  of  using  sinapisms  will  be  described  in 
Demonstration  19. 

Methods  of  Using  Articles  Employed  for  Applying 
Dry  Heat  to  the  Body 

To  fill  a  hot-water  bag,  remove  the  stopper  and 
roll  the  bag  from  the  bottom  upward  so  as  to  expel 
the  air,  otherwise,  the  hot  water  is  likely  to  spurt 
out  over  your  hands,  being  forced  out  by  the  ex- 
panding air.1  Let  the  water  flow  in,  this  should 
not  be  hotter  than  about  1 80°  F.  If  the  bag  is  to  be 
put  on  the  body  do  not  fill  it  to  more  than  about  one 
quarter  to  half  its  capacity,  or  it  will  be  too  heavy; 
if  it  is  to  lie  on  the  bed,  you  can  put  more  water  in, 
but  do  not  fill  it  to  its  full  capacity.  Insert  the 
stopper  and,  after  doing  so,  hold  the  bag  upside 
down  to  ascertain  if  there  is  leaking,  this  most 
frequently  occurs  around  the  stopper  as  the  result 
of  an  absent  or  defective  washer.  Put  the  bag  in  a 
flannel  or  flannelet  cover,  stopper  first,  so  that  if 
the  cover  becomes  loosened  the  metal  stopper  will 
not  come  near  the  patient,  for,  as  metal  absorbs 
and  parts  with  heat  more  readily  than  rubber,  it 
is  much  more  likely  to  cause  a  burn. 

It  is  to  be  remembered  (i)  that  a  patient's  word 
is  never  to  be  relied  upon  as  to  the  suitability  of 
the  temperature  of  a  hot  application,  because  if  a 
person  is  in  pain  a  burning  sensation  may  not  be 

1  It  will  be  remembered  that  air  is  expanded  by  heat. 


i8o  Nursing  Methods 

perceived  or  it  may  be  a  relief.  (2)  The  hand  is 
not  as  sensitive  to  heat  as  other  parts  of  the  body 
and  therefore  when  testing  a  hot  application  hold 
it  against  your  arm  or  cheek.  (3)  Some  people 
are  more  easily  burnt  than  others  and  therefore 
when  a  hot-water  bag  or  other  hot  application  is 
placed  directly  on  the  skin  look  at  the  latter  after 
a  few  minutes  and  see  if  it  is  a  deep  red,  if  so,  the 
application  is  probably  too  hot;  this  care  is  es- 
pecially necessary  with  small  children  and  the  aged. 

Warm  salt  is  sometimes  used  as  a  hot  applica- 
tion when  a  hot-water  bottle  cannot  be  obtained. 
To  heat  the  salt,  empty  it  into  a  pan  and  place  it, 
preferably,  in  a  hot  oven,  though  it  can  be  heated 
on  top  of  the  stove.  Stir  it  occasionally,  and  when 
hot  enough  pour  it  into  a  muslin  bag. 

Two  important  things  to  remember  about  elec- 
tric pads  are:  (i)  The  insulating  material  wears 
off  in  the  course  of  time  and  thus  old  pads  should 
be  inspected  before  use ;  bedclothes  have  caught 
fire  from  defective  insulating  material.  (2)  Pads 
may  become  dangerously  hot  after  they  have  been 
in  use  for  some  time. 

Ironing  the  affected  part  with  a  flatiron  will  often 
afford  great  relief  in  conditions  such  as  stiff  neck 
and  lumbago.  To  do  this,  dry  the  skin  thoroughly, 
cover  it  with  a  piece  of  flannel,  and  pass  a  heated 
iron  back  and  forth  over  the  latter  for  about  twenty 
minutes.  Have  the  iron  as  hot  and  make  as  much 
pressure  as  the  patient  can  endure.  It  may  be 
necessary  to  press  lightly  at  first  and  increase  the 


External  Applications         181 

degree  gradually.    Raise  the  flannel  from  time  to 
time  to  see  that  the  skin  is  not  too  deep  a  red. 

Methods  of  Using  Articles  Employed  for  Cold 
Applications 

The  special  points  to  remember  in  connection 
with  the  use  of  ice-caps  are :  I .  To  break  the  ice 
into  pieces  about  the  size  of  a  walnut ;  if  the  pieces 
are  larger  than  this  the  cap  is  not  likely  to  fit  over 
the  part  well,  if  smaller  they  will  melt  too  quickly. 

2.  Let  some  hot  water  run  over  the  ice  to  blunt 
the  sharp  edges  which  might  pierce  the  rubber. 

3.  Roll  up  the  sides  of  the  cap  before  putting  in 
the  ice,  and,  after  doing  so,  squeeze  it  above  the 
ice,  to  expel  the  air. 

4.  Do  not  fill  a  cap  more  than  three  quarters 
its  capacity  and  not  even  this  much  when  its  weight 
will  cause  discomfort.     Cover  it  with  a  piece  of 
thin  muslin. 

5.  If  the  weight  of  a  cap  annoys  the  patient  tie 
the  cap  to  some  support  such  as  a  bed-cradle  or  the 
substitute  mentioned  on  page  78,  and  place  this 
so  that  the  cap  will  barely  rest  upon  the  part. 

The  care  of  ice-caps  after  use  was  described  in 
Chapter  I. 

Cold  compresses  are  sometimes  used  as  sub- 
stitutes for  ice-caps  as  a  means  of  applying  cold  to 
the  forehead.  To  use  them,  arrange  the  tray  as 
described  on  page  1 76  (the  ice  is  raised  above  the 
water  because  this  retards  the  melting).  Saturate 


1 82  Nursing  Methods 

the  compresses  in  the  water  and  then  place  them 
on  the  ice.  When  one  is  thoroughly  chilled  squeeze 
the  water  from  it  and  place  it  on  the  forehead. 
When  it  becomes  warm  replace  it  on  the  ice  and 
put  the  cool  one  on  the  forehead. 

Cold  compresses  for  the  eyes  are  used  in  the 
same  manner  except  that,  as  a  rule,  a  number  of 
them  are  provided  for  they  need  to  be  changed 
more  frequently  and,  if  there  is  any  discharge  from 
the  eyes,  the  same  one  should  not  be  used  twice. 
Separate  compresses  should  be  used  for  each  eye  if 
both  eyes  are  being  treated. 

A  very  important  thing  to  remember  about  the 
use  of  cold  is  that  as  long  as  the  treatment  is  con- 
tinued the  use  of  the  cold  must  be  constant  for, 
otherwise,  the  reaction  effects  described  in  Chapter 
VI  will  occur  during  the  intervals  that  the  cold  is 
reduced  and  this  is  likely  to  be  harmful  in  some 
conditions  for  which  local  cold  applications  are 
prescribed. 

Demonstration  19 
Preparing,   Applying,   and  Removing  Sinapisms 

Equipment:  i.     Mustard  plaster. ' 

2.  Mustard. 

3.  Flour. 

4.  Tepid  water. 
5-    Oil. 

1  Mustard  plasters  are  commonly  called  mustard  leaves. 


External  Applications         183 

6.  Bowl. 

7.  Spatula. 

8.  Tablespoon. 

9.  Plate. 

10.  Gauze. 

11.  Two  towels. 

These  will  not  be 


12.  Basin  of  warm  water. 

13.  Washcloth. 


needed  until  the 
paste  is  to  be  re- 
moved. 


Some  important  facts  to  remember  regarding 
the  use  of  mustard  are :  The  counterirritant  action 
and  flavor  of  mustard  are  due  to  a  volatile  oil 
which  is  developed  by  the  action  of  a  ferment  that 
is  contained  in  the  mustard  and  becomes  active 
when  the  mustard  is  wet.  This  ferment  is  de- 
stroyed by  a  temperature  exceeding  140°  F.  (60°  C.) 
and  its  action  is  inhibited  at  considerably  lower 
temperatures  so  that,  if  the  liquid  with  which  the 
mustard  is  mixed  is  hotter  than  about  106°  F.  the 
amount  of  oil  developed  (and  hence  the  counter- 
irritant  action  of  the  mustard)  will  be  limited. 
Nevertheless,  mustard  is  considerably  used  in  hot 
poultices  and  baths  because,  if  it  is  only  added  to 
the  heated  substance  just  before  the  latter  is  used 
it  will  have  a  slight  counterirritant  effect  for  a 
short  time  and  thus  increase  the  effects  of  the  heat, 
but  when  the  counterirritant  effect  is  to  depend 
solely  upon  the  mustard  the  water  used  must  not 
be  hotter  than  106°  F.  The  ferment  becomes  less 


1 84  Nursing  Methods 

active  when  mustard  is  kept  for  any  length  of 
time,  especially  in  hot  weather,  and  thus  in  summer 
time  and  in  hot  countries  it  is  usually  necessary  to 
use  relatively  more  mustard.  When  preparing  a 
mustard  paste  for  a  child  or  an  aged  person  it  is 
well  to  add  a  little  oil,  because  this  softens  the  skin 
and  thus  lessens  the  tendency  of  the  outer  layer  to 
separate  from  the  derma  as  described  on  page  173. 
The  skin  should  be  washed  when  a  sinapism  is  re- 
moved because  particles  of  mustard  are  likely  to 
adhere  to  it  and  cause  blistering. 

Procedure  in  the  use  of  mustard  plasters : 

To  prepare  a  leaf  for  use,  dip  it  in  tepid  water, 
fold  it  in  a  gauze  compress,  arranging  the  latter 
with  only  one  thickness  over  the  mustard  surface. 
Lay  the  leaf,  mustard  surface  uppermost,  on  a 
folded  towel.  Leave  this  towel  in  place  when  you 
apply  the  leaf  as  it  will  protect  the  patient's  night- 
gown and  the  bedcovers  from  the  moisture.  It  is 
rarely  necessary  to  secure  a  sinapism  in  place  and, 
usually,  it  is  better  not  to  do  so  as,  if  it  is  loose,  the 
color  of  the  skin  can  be  more  easily  watched,  which 
is  imperative,  for  mustard  blisters  some  skins  very 
readily. 

Remove  the  leaf  when  the  skin  is  well  reddened. 
This  is  usually  in  about  twenty  minutes,  but,  some- 
times, in  ten  or  even  less.  Wash  the  skin  with 
warm  water  and  dry  it.  Make  sure  that  no  par- 
ticles of  mustard  adhere  to  the  skin.  If  the  skin  is 
very  red,  apply  some  oil  or  other  lubricant. 

Mustard  pastes  are  made  of  mustard,  flour,  and 


External  Applications         185 

tepid  water  and,  for  the  reason  given  on  page  184, 
oil  is  sometimes  added.  The  relative  proportion 
of  mustard  to  flour  required  varies  for  the  reasons 
given  on  page  184.  Ordinarily,  in  a  temperate 
climate,  about  one  part  of  mustard  to  three  or  four 
of  flour  is  necessary  for  an  adult  and  one  to  six  or 
eight  for  a  child.  About  five  tablespoons  of  mate- 
rial are  needed  to  make  a  paste  six  inches  square. 

Procedure :  Put  the  mustard  in  a  bowl ;  crush  all 
lumps. 

Add  the  flour  and  mix  the  two  ingredients 
thoroughly. 

If  oil  is  to  be  used,  add  about  two  teaspoonfuls. 

Add  enough  tepid  water  to  make  a  paste  that  can 
be  spread  easily,  but  that  will  not  run. 

Lay  a  gauze  compress  on  a  plate  and  spread  the 
paste  in  the  center  of  the  former,  about  one  eighth 
inch  thick.  Fold  the  edges  of  the  gauze  over  the 
back  of  the  paste. 

Place  the  paste,  the  side  with  single  layer  of 
gauze  uppermost  (this  is  the  side  that  goes  next 
the  skin),  on  a  folded  towel.  Put  it  on  the  patient. 
Take  the  same  precautions  while  it  is  on  and  when 
removing  it  as  for  a  mustard  leaf. 

Demonstration  20 
Making  and  Applying  Poultices 

Requisites  for  demonstration:  i.    Flaxseed. 
2.     Baking  powder  or  sodium  bicarbonate. 


1 86  Nursing  Methods 

3.  Mustard. 

4.  Boiling  water. 

5.  Cup  measure. 

6.  Utensils  provided  for  cooking  poultices  in. 

7.  Stove. 

8.  Spatula  or  knife. 

9.  Tablespoon. 

10.  Towel. 

11.  A  piece  of  board  or  large  platter. 

12.  Flannel  cut  the  size  and  shape  required  for 
the  poultice. 

13.  Binder  and  pins. 

14.  Gauze  or  thin  muslin  on  which  to  spread 
the  poultices.    For  a  square  or  oblong  poultice  this 
can  be  cut  twice  the  size  that  the  poultice  is  to  be, 


NECK 


ARMHOUZ  ARM  HOLE 


Fig.  42.    Shape  of  poultice  to  cover  chest. 

plus  about  three  inches  to  allow  for  turning  over 
the  edges  of  the  paste,  which  is  spread  on  one  half 
of  the  material  and  covered  with  the  other  half,  but 
when  any  complex  shape  is  needed  (e.  g.,  for  the 
chest)  it  is  well  to  have  fairly  firm  muslin  for  the 
foundation  and  gauze  or  thin  muslin  for  the  cover, 
and  to  cut  these  the  required  shape.  See  Fig.  42. 


External  Applications         187 

Cut  the  foundation  two  and  the  cover  three  inches 
larger  on  all  sides  than  the  finished  poultice  needs 
to  be. 


Fig.  43.     Shape  of  binder  to  retain  poultice  in  place. 

15.  A  doubled  piece  of  flannelet  the  shape  of 
the  poultice  with  which  to  cover  the  part  after 
the  removal  of  the  poultice. 

1 6.  Oil  or  vaseline,  a  gauze  or  cotton  sponge 
with  which  to  apply  it,  and  a  dish  to  put  the  latter 
in  after  use. 

17.  Antiphlogistin  and  a  small  empty  bowl  or 
jar.    A  saucepan  containing  water.1 

1 8.  Some  stale  bread.1 

19.  The  demonstration  doll. 

20.  A  stove. 

The  points  of  special  importance  to  consider 
when  making  a  poultice  are :  To  have  it  as  light 2 

'These  need  only  be  provided  if  desired  for,  if  the  pupils 
are  shown  how  to  make  a  linseed  poultice,  they  should,  at  any 
time,  be  able  to  make  any  other  kind  by  following  printed  or 
verbal  instruction. 

2  A  poultice  to  cover  the  chest  should  not  be  more  than  half 
an  inch  thick,  for  a  weight  on  the  chest  may  interfere  with  breath- 
ing. A  small  poultice  can  be  about  three  quarters  of  an  inch 


1 88  Nursing  Methods 

as  possible  and  as  hot  as  it  can  be  used  without 
burning  the  patient;  to  make  it  of  a  consistency 
that  will  allow  of  its  being  spread  easily,  but  not  so 
thin  that  it  will  spread  of  itself  and  thus  run  from 
the  covering. 

Flaxseed  Poultice 

Procedure :  Put  the  water  to  boil  (about  one  and 
a  half  pints  will  be  required  for  a  medium-sized 
poultice  for  the  chest). 

Spread  a  towel  on  the  board  and  on  this  lay  the 
oil  muslin  or  flannel ;  cover  the  latter  with  the  gauze 
or  muslin  on  which  the  flaxseed  is  to  be  spread. 

When  the  water  is  boiling  forcibly,  add  flaxseed 
to  it  slowly  (do  not  allow  the  water  to  stop  boiling), 
and  stir  the  mixture  with  the  spatula  as  you  do  so. 

When  the  paste  is  just  thick  enough  for  some 
dropped  from  the  spatula  to  retain  its  shape  for  a 
minute  add  about  one  third  of  a  tablespoon  ful  of 
baking  powder  or  sodium  bicarbonate  and  beat  the 
mixture  thoroughly. 

Turn  the  poultice  on  to  the  muslin  and  fill  the 
pan  with  hot  water. x 

Spread  the  paste  on  the  muslin  to  within  two 
inches  of  the  edges  as  quickly  as  possible.  Turn 
up  the  edges  of  the  muslin  over  the  paste. 

thick.  When  baking  powder  and  sodium  bicarbonate  are  moistened 
gas  (COa)  is  liberated  and,  therefore  if  either  one  is  added  to  a 
poultice,  it  tends  to  make  it  lighter,  and,  as  gas  is  a  poor  heat 
conductor,  to  assist  in  the  retention  of  heat. 

1  If  the  flaxseed  is  allowed  to  dry  in  the  pan  the  latter  will  be 
much  harder  to  clean. 


External  Applications         189 

Cover  the  latter  and  turn  the  edges  of  the  cover 
between  the  foundation  and  protector  (i.e.,  the 
flannel). 

Fold  the  poultice,  including  the  protector,  and 
wrap  the  towel  around  it. 

Wash  and  put  away  the  cooking  utensils.1 

Carry  the  poultice  (folded  in  the  towel)  and  the 
binder  and  pins  to  the  patient. 

To  apply  the  poultice :  Turn  back  the  bedcovers 
as  much  as  necessary  and  slip  the  binder  under  the 
part  to  which  the  poultice  is  to  be  applied 

Turn  back  the  nightgown  as  much  as  required 
and  if  the  patient  is  old  or  a  small  child  rub  some 
oil  or  vaseline  over  the  area  to  which  the  poultice 
is  to  be  applied.  Cover  the  part  with  the  towel 
that  is  around  the  poultice. 

Test  the  temperature  of  the  poultice  with  the 
back  of  your  hand. 

Slip  the  poultice  under  the  towel,  but  do  not  un- 
fold it  all  at  once.  Keep  raising  and  lowering  it 
until  the  patient  becomes  accustomed  to  the  heat. 
Notice  the  color  of  the  patient's  skin  and  judge  by 
this,  rather  than  the  patient's  opinion,  if  the  poul- 
tice is  too  hot.  If  it  does  not  cause  a  very  intense" 
redness,2  spread  it  out  over  the  part,  remove  the 

1  If  the  poultice  is  boiling  when  turned  on  to  the  muslin  and 
spread  quickly  and  the  utensil  washed  and  put  away  speedily, 
it  is  quite  possible  for  this  to  be  done  before  the  poultice  becomes 
cool  enough  to  be  applied. 

1  This  should  always  be  the  guide  when  making  hot  applica- 
tions of  any  kind,  because  some  skins  will  blister  much  more 
readily  than  others,  and,  if  a  patient  is  in  pain,  heat,  even  in- 


190  Nursing  Methods 

towel,  and  secure  the  binder;  do  not,  however, 
fasten  it  tightly,  especially  around  the  chest,  as 
this  may  interfere  with  breathing. 

Fold  the  towel  and  keep  it  to  roll  the  poultice  in 
when  the  latter  is  removed. 

A  poultice  should  not  be  left  on  longer  than  three 
quarters  of  an  hour,  for  by  that  time  it  will  be  no 
hotter  than  the  skin  and  thus  of  no  further  value. 

To  remove  a  poultice:  Take  the  flannelet  pro- 
tector or  a  fresh  poultice,  towel,  oil,  and  pledgets 
to  the  bedside.  Cover  the  poultice  that  is  on  the 
patient  with  the  towel,  moving  the  bedcovers  and 
nightgown  out  of  the  way  as  you  do  so. 

Remove  the  poultice  from  under  the  towel  and 
dry  the  skin  by  rubbing  your  hand  over  the  towel. 

Look  at  the  skin  and,  if  it  is  very  red,  rub  some 
oil  over  it. 

Put  on  the  pad  or  fresh  poultice  and  when  it  is  in 
place  remove  the  towel  and  wrap  it  around  the 
poultice  that  is  to  be  taken  away. 

Mustard  Poultice 

To  make  a  mustard  poultice:  Proceed  as  for  a 
plain  flaxseed  poultice,  but  dissolve  some  mustard 
in  tepid  water,  using  for  an  adult  one  tablespoonful 
of  mustard  for  each  cup  of  flaxseed,  and  for  a  child 
half  this  amount  of  mustard,  and,  just  before  add- 


tense  enough  to  burn,  may  be  a  relief,  while  on  the  other  hand, 
some  patients  will  object  to  even  a  moderate  degree  of  heat. 


External  Applications         191 

ing  the  baking  powder  or  soda,  pour  in    the  dis- 
solved mustard. 

For  the  reasons  given  on  page  183,  when  mustard 
is  added  to  anything  the  temperature  of  a  flaxseed 
poultice,  the  counterirritant  action  of  the  mustard 
is  much  diminished,  but  it  does  add  slightly  to 
that  of  the  poultice. 

Antiphlogistin  Poultice 

To  prepare  an  antiphlogistin  poultice  stand  the 
container  in  a  pan  of  boiling  water.  Keep  the  water 
boiling  until  the  antiphlogistin  is  considerably  hot- 
ter than  could  be  borne  by  the  skin  (to  allow  for 
cooling),  stir  the  antiphlogistin  occasionally  so  that 
it  will  be  equally  heated.  Either  spread  it  direct- 
ly on  the  skin  or  on  muslin,  if  the  latter,  place  the 
uncovered  antiphlogistin  next  the  skin,  cover  the 
application  with  absorbent  cotton  and  secure  it  in 
place  with  a  bandage  or  binder. 

Remove  the  poultice  when  it  is  cooler  than  the 
skin  or  if  it  becomes  dried.  This  may  not  be  for 
several  hours. 

Bread  Poultice 

To  make  a  bread  poultice:  Soak  the  bread  in 
boiling  water  until  it  is  soft,  beat  it  with  a  fork; 
bring  it  to  boiling  point;  pour  off  any  water  that 
has  not  been  absorbed;  proceed  as  for  a  linseed 
poultice. 


i92  Nursing  Methods 

Demonstration  21 
Application  of  Fomentations  or  Stupes 

Fomentations,  as  previously  stated,  consist  of 
soft  material  wrung  out  of  boiling  water.  Flannel 
and,  for  the  eyes,  absorbent  cotton  are  the  best 
materials  to  use  because  they  hold  heat  for  a  rela- 
tively long  time.  Fomentations  are  most  com- 
monly used  (i)  on  the  abdomen  to  cause  the 
expulsion  of  gas  and  (2)  on  the  eyes  to  overcome 
certain  forms  of  inflammation. 

Requisites  for  abdominal  stupes,  Method  i : 

1.  A  gas  or  electric  stove  and  a  tray  on  which 
to  stand  it  and,  if  the  table  on  which  these  are 
placed  will  be  injured  by  heat,  something  (as  wood 
or  a  folded  towel)  that  is  a  poor  heat  conductor  to 
put  under  the  tray. 

2.  Matches,  if  necessary. 

3.  A  basin  of  boiling  water. 

4.  Wadding  or  a  fold  of  flannelet  the  size  of  the 
abdomen. 

5.  Two  pieces  of  flannel  twice  the  size  of  the 
area  for  application. 

6.  A  coarse  towel. 

7.  A  blanket  or  shoulder  wrap. 

8.  The  demonstration  doll. 

Requisites  for  Method  2:  The  same  as  for 
Method  i  with  the  following  exceptions:  No 
blanket  and  stove  are  required ;  the  boiling  water  is 
to  be  in  a  pitcher  and  the  basin  empty,  but  warmed ; 
a  binder  and  safety  pins  will  be  needed. 


External  Applications         193 

Requisites  for  fomentations  for  the  eyes:  I. 

Compresses  of  absorbent  cotton  about  one  and  a 
half  inches  square,  the  number  depending  upon 
conditions,  for,  if  there  is  suppuration,  the  same 
compress  must  not  be  used  twice;  otherwise,  five 
or  six  will  probably  be  enough. 

2.  A  towel. 

3.  A  bath  thermometer. 

4.  A  pitcher  of  boiling  and  one  of  cold  water  or 
whatever  solution  is  prescribed. 

5.  A  dressing  basin. 

6.  A  bag  or  other  receptacle  for  used  com- 
presses. 

7.  If  the  treatment  is  to  be  continued  for  any 
length  of  time,  a  pail  or  jar  and  a  stove. 

8.  If  the  treatment  is  for  a  communicable  in- 
fection or  following  operation,  gloves.    These  must 
be  sterile  for  the  latter  condition. 

These  articles  should  all  be  arranged  in  con- 
venient order  on  a  tray. 

Abdominal  Stupes 

Procedure  for  Method  i :  Arrange  the  stove, 
light  the  gas,  put  on  the  basin  of  boiling  water. 

Double  one  of  the  pieces  of  flannel.  Place  it  in 
the  center  of  the  towel  or  wringer  and  put  as  much 
of  this  as  envelops  the  flannel  in  the  boiling  water, 
but  leave  the  ends  hanging  over  the  side  of  the 
basin. 

Put  the  blanket  over  the  patient's  chest  and 
13 


194  Nursing  Methods 

abdomen  and  turn  down  the  bedcovers  to  the 
groin. 

Turn  the  nightgown  up  above  the  abdomen. 
Cover  the  latter  with  the  flannelet. 

Wring  the  water  out  of  the  flannel  by  twisting  the 
two  ends  of  the  towels  in  opposite  directions.  Do 
this  until  it  is  impossible  to  wring  out  any  more  water. 

Remove  the  flannel  from  the  towel;  give  it  a 
quick  shake  and  pass  it  (doubled)  under  the  pro- 
tector (be  sure  that  it  is  not  too  hot) ;  spread  it  out 
over  the  abdomen. 

Place  the  other  piece  of  flannel  in  the  towel  and 
this  in  the  boiling  water  and,  after  three  minutes 
have  elapsed,  use  this  flannel  to  replace  that  on 
the  abdomen. 

The  stupes  are  to  be  changed  without  removing 
the  protector  or  blanket,  but  you  must  raise  these 
slightly  each  time  you  make  a  change  to  ascertain 
the  color  of  the  skin. 

Continue  the  treatment  the  length  of  time  pre- 
scribed; this  is  usually  twenty  minutes. 

Dry  the  abdomen.  Sometimes  it  is  covered  with 
wadding  or  folded  flannelet. 

Method  2 :  Prepare  the  patient  as  for  Method  i , 
but  it  is  not  necessary  to  replace  the  bedcovers 
with  a  blanket  on  the  upper  part  of  the  body,  as 
the  covers  can  be  moved  from  over  the  abdomen 
sufficiently  without  uncovering  any  other  part  of 
the  body. 

Pass  a  binder  under  the  patient  in  position  to  be 
pinned  around  the  abdomen. 


External  Applications         195 

Put  the  flannel  in  the  towel  or  wringer  and  this, 
except  the  two  ends,  in  the  basin.  Pour  the  boiling 
water  over  the  part  containing  the  flannel. 

Wring  the  stupe  and  apply  it  as  in  Method  i. 
Draw  up  the  sides  of  the  binder  and  pin  it. 

Change  the  stupe  every  ten  or  fifteen  minutes. 
The  treatment  is  usually  continued  until  it  affords 
relief. 

Eye  Fomentations 

Procedure:  Put  a  towel  under  the  patient's 
head. 

Pour  some  water  or  solution  into  the  bowl  and 
make  it  the  required  temperature ;  this  is  generally 
about  no0  F. 

Put  in  some  pledgets ;  squeeze  the  water  from  one 
and  put  it  on  the  eye.  Change  this  in  two  minutes 
for  a  hot  one.  If  there  is  any  suppuration  a  fresh 
pledget  must  be  used  for  each  application.  Con- 
tinue the  treatment  the  required  length  of  time  and 
keep  the  solution  at  the  prescribed  temperature. 

If  both  eyes  are  to  be  treated  use  separate  bowls 
and  compresses  for  each  eye  and  squeeze  the  com- 
presses for  each  eye  with  a  different  hand. 


CHAPTER  DC 
Care  of  Children 

Normal  development  of  children  and  measures  to  promote  it. 
Some  especially  important  facts  regarding  mental  development. 
Requirements  for  health.  Method  of  taking  a  baby's  tempera- 
ture. Suitable  clothing  for  an  infant.  Care  of  diapers.  Demon- 
stration 22:  Lifting,  weighing  and  dressing  a  baby.  Reasons  for 
the  modification  of  milk.  Care  necessary  in  the  preparation  of 
an  infant's  food  and  in  its  feeding.  Care  of  feeding  bottles  and 
nipples.  Demonstration  23:  Preparation  of  an  infant's  food  and 
the  care  of  utensils  required  for  the  purpose. 

Normal  Development  of  Children  and  Measures 
to  Promote  It 

Knowledge  of  what  constitutes  a  normal  rate 
of  development  is  of  great  assistance  in  taking 
care  of  children  and  therefore  some  of  the  more 
important  facts  regarding  it  will  be  given  here 
though  space  will  not  allow  of  going  into  detail. 

The  table  following  shows  the  average  relative 
weight  and  height  of  normal  children  at  different 
ages  and  is  a  good  indication  of  what  the  rate  of 
growth  should  be. 

196 


Care  of  Children 


Weight 

Height 

Weight 

Height 

Age 

Sex 

Age 

Sex 

Pounds 

Inches 

Pounds 

Inches 

Birth 

Boys 

7-5 

2O.  I 

5  years 

Boys 

41.4 

41.7 

Girls 

7-i 

19.9 

Girls 

JO.  2 

41-3 

6  months 

Boys 

16.0 

25-4 

6  years 

Boys 

45-i 

44.0 

Girls 

I5-50 

25.0 

Girls 

43-5 

43-5 

i  year 

Boys 

21.2 

29.0 

7  years 

Boys 

49-5 

46.1 

Girls 

20-4 

28.2 

Girls 

47.8 

45-8 

1  8  months 

Boys 

22.8 

30.0 

8  years 

Boys 

54-5 

48.5 

Girls 

22.O 

29-5 

Girls 

52.2 

47.8 

2  years 

Boys 

28.5 

33-0 

9  years 

Boys 

59-8 

50.0 

Girls 

27.8 

22.7 

Girls 

57-4 

49.6 

3  years 

Boys 

33-5 

36.0 

10  years 

Boys 

66.0 

52.0 

Girls 

31-5 

35-5 

Girls 

63.0 

51-7 

4  years 

Boys 

36.4 

38.6 

Girls 

35-i 

38.3 

During  the  first  five  months  of  life  a  normal 
baby,  after  the  first  few  days,  will  gain  on  an 
average  about  four  and  a  half  to  seven  ounces 
weekly  and,  from  this  time  until  it  is  a  year  old, 
about  two  and  a  half  to  four  ounces  weekly ;  after 
this,  as  can  be  seen  in  the  table,  growth  is  less 
rapid. 

The  development  of  a  normal  infant's  muscles 
is  about  as  follows :  Those  of  the  neck  are  usually 
sufficiently  strong  to  allow  a  baby  to  hold  its  head 
up  by  about  the  end  of  the  third  month,  those  of 
the  back  are  strong  enough  to  allow  the  child  to 
sit  up  unsupported  by  the  seventh  or  eighth  month 
and  soon  after  this  it  will  be  able  to  creep.  As  soon 
as  it  is,  creeping  should  be  encouraged  because  it 
will  strengthen  the  muscles  involved,  namely, 


198  Nursing  Methods 

those  of  the  abdomen,  buttocks,  and  thighs.  An 
infant's  pen  furnishes  an  excellent  means  of  allow- 
ing a  child  to  creep  about  without  getting  into 
danger  and  one  can  be  made  with  a  packing  case 
that  will  answer  the  purpose  as  well  as  anything 
that  can  be  bought.  The  case  should  be  about 
eighteen  inches  high  and  large  enough  to  allow 
the  child  to  move  about  freely.  A  washable  lining 
should  be  tacked  in  it  in  such  a  manner  that  it  can 
be  removed  when  soiled.  A  baby's  clothes  must 
also  be  considered  in  connection  with  muscle 
development  because  exercise  is  essential  for 
proper  development  and  the  clothing  must  there- 
fore not  interfere  with  free  movement,  especially 
that  of  the  legs. 

The  bones  of  the  legs  and  spine  are  usually 
strong  enough  for  a  child  to  stand  and  begin  to 
walk  when  it  is  about  a  year  old,  but  a  baby  should 
not  be  allowed  to  do  so  much  sooner  because,  until 
this  time,  the  bones  do  not  contain  enough  mineral 
matter  to  make  them  sufficiently  firm  to  bear  its 
weight  without  bending  and,  therefore,  a  baby 
that  is  allowed  to  stand  and  walk  too  soon  is  likely 
to  become  bow-legged  and  to  acquire  an  abnormal 
spinal  curvature.  A  child's  legs  are  also  likely  to 
become  bowed  if  its  diapers  are  so  large  that  they 
keep  the  legs  in  an  abnormal  position. 

The  cutting  of  the  first  teeth  is  about  as  follows : 

Names  of  Teeth.  Month  of  Appearance. 

2  lower  central  incisors  6th-  8th 

2  upper  central  incisors  8th- 1 2th 


Care  of  Children  199 

Names  of  Teeth.  Month  of  Appearance. 

2  upper  lateral  incisors  ioth-i2th 

2  lower  lateral  incisors  1 2th- 1 5th 

4  anterior  molars  1 4th- 1 6th 

4  canine  i8th-2Oth 

4  posterior  molars  i2th~3Oth 

The  incisors  are  the  central  teeth,  there  are  four 
in  each  jaw;  the  canine  are  the  pointed  teeth,  there 
are  two  in  each  jaw,  one  on  either  side  of  the  in- 
cisors; the  anterior  molars  (known  also  as  bi- 
cuspids) are  behind  the  canine  and  the  posterior 
molars  behind  the  anterior. 

Delay  in  the  cutting  of  the  teeth  much  beyond 
the  ages  mentioned  above  is  usually  indicative  of 
poor  nutrition. 

The  appearance  of  the  second  set  of  teeth  is 
usually  as  follows : 

Names  of  Teeth.  Age  of  Eruption. 

First  molars  6th-  7th  year 

Central  and  lateral  incisors  yth-  Qth    ' 

Bicuspids  9th-ioth    " 

Canines  I2th-i4th    " 

Second  molars  I2th-i6th    " 

Wisdom  teeth  or  third  molars  1 7th-2ist  or  even  later 

A  very  prevalent,  but  mistaken,  idea  regarding 
the  teeth  is  that  care  of  the  first  set  is  not  impor- 
tant. On  the  contrary,  if  these  are  not  cared  for 
in  the  proper  way,  bacteria  are  likely  to  reach  their 
roots  and  bring  about  conditions  which  will  injure 
the  permanent  ones;  it  is  to  be  remembered  that, 
though  the  permanent  teeth  do  not  appear  through 


200  Nursing  Methods 

the  gums  until  the  ages  specified  above,  they  begin 
to  form  in  early  infancy.  Also,  if  the  milk  teeth 
are  lost  too  soon  the  shape  and  condition  of  the 
alveoli  (cavities  through  which  the  teeth  come  and 
in  which  their  roots  remain)  may  be  so  altered 
that  the  shape  and  normal  condition  of  the  per- 
manent teeth  will  be  interfered  with. 

Proper  care  of  the  teeth  (first  or  second)  implies 
having  them  filled  if  cavities  form  and  brushing 
them  at  least  twice  a  day  with  (in  the  case  of 
children)  a  small,  very  soft  toothbrush1  and  a  little 
tooth  paste  or  powder.  The  brush  should  be 
moved  backward  and  forward  across  the  teeth,  and 
also  downward  on  the  upper  teeth  and  upward 
on  the  lower,  in  front  and  behind.  It  is  important 
that  this  direction  be  observed  because,  moving 
the  brush  upward  on  the  upper  teeth  and  down- 
ward on  the  lower  tends  to  make  the  gums  recede 
from  the  teeth  and  to  brush  foreign  substances 
under  the  gums  and  this  favors  the  formation  of 
abscesses  in  the  alveoli.  Some  of  the  bad  effects 
that  may  result  from  such  infection  are  mentioned 
on  page  147. 

Some  of  the  body  glands  are  very  imperfectly 
developed  at  birth.  The  lacrimal  glands2  (see 

1  The  prophylactic  toothbrush  is  a  particularly  good  variety 
because  the  brush  is  curved  in  a  manner  that  allows  it  to  follow 
the  contour  of  the  jaw,  and  the  bristles  are  so  arranged  that  they 
get  between  the  teeth. 

2  The  lacrimal  glands  are  situated  just  above  the  eyeballs  at 
their  outer  angles.    They  secrete  the  tears.    The  tears  are  neces- 
sary to  keep  the  anterior  of  the  eyeball  moist  and  free  from  dirt; 


Care  of  Children 


20 1 


Fig.  44)  are  not  sufficiently  developed  to  secrete 
tears  until  the  third  or  fourth  month,  and,  especi- 

,  Lachrymal 

L-  Gland  3 


Fig.  44.     The  lacrimal  apparatus  of  the  right  eye. 

ally  during  this  time,  a  baby's  eyes  must  be  most 
carefully  protected  from  strong  light,  dust,  and 
all  forms  of  irritation.  During  infancy  the 
glands1  that  secrete  digestive  juices  have  very 
limited  power  to  manufacture  the  enzymes2  re- 

they  pass  across  the  eyeball  and,  if  not  evaporated,  into  small 
channels  that  lead  into  the  nose.  Ordinarily,  we  are  not  aware  of 
this  secretion  because  evaporation  just  about  keeps  pace  with 
secretion,  but,  irritation  of  the  eyes  or  psychic  stimulation  of  the 
glands  induces  such  excessive  secretion  that  the  tears  flow  over 
the  cheeks  and  into  the  nose.  Injury  to  these  glands  which  pre- 
vents them  secreting  may  result  in  blindness  because  the  conse- 
quent dryness  of  the  membrane  covering  the  eyes  and  its  irri- 
tation by  dust,  etc.,  induces  inflammation  and  thickening  which 
interferes  with  the  passage  of  light  rays  to  the  retina,  see  page  1 66. 

'  These  are  (i)  the  salivary  glands,  which  discharge  their  con- 
tents into  the  mouth;  (2)  glands  in  the  wall  of  the  stomach  and 
small  intestine;  (3)  the  pancreas;  (4)  the  liver. 

1  Chemical  substances,  made  by  certain  animal  cells  and  plants, 
which  assist  chemical  reactions. 


202  Nursing  Methods 

quired  for  digestion.  Only  those  needed  for  the 
digestion  of  milk  are  made  at  first  and  but  small 
amounts  of  these.  The  ferments  necessary  for 
the  digestion  of  starch  are  not  secreted  in  any 
amount  until  a  baby  is  nearly  a  year  old  and, 
therefore  any  starchy  food  given  an  infant  must 
be  predigested. x  Also  the  functioning  ca- 
pacity of  some  of  the  glands  which  make  the 
hormones2  necessary  for  metabolism3  develops 
slowly  and  thus  infants  are  very  dependent  upon 
chemical  substances  known  as  vitamines  present 
in  fresh  milk,  and  older  children  upon  those  in  fresh 
fruit,  vegetables,  butter,  and  meat.  Vitamines  are 
destroyed  by  a  high  temperature  and  by  drying 
and,  therefore,  if  a  baby  is  fed  with  sterilized  milk  it 
is  likely  to  develop  a  disease  due  to  defective  meta- 
bolism such  as  scurvy  or  rickets. 

The  mucous  membrane  lining  the  alimentary 
tract4  is  very  delicate  and  easily  irritated  during 
childhood,  and  foods  containing  spices  and  other 
irritant  condiments  may  cause  harmful  conditions 


1  The  same  changes  that  are  produced  in  starch  during  diges- 
tion can  be  caused  by  long-continued  cooking  and  by  a  ferment, 
known  as  diastase,  which  is  obtained  from  malted  barley. 

"Chemical  substances,  some  of  which  are  enzymes,  that  are 
absorbed  from  the  glands  in  which  they  are  secreted  by  the  blood 
and  carried  to  other  parts  of  the  body  where  they  either  hasten 
chemical  reactions  or  stimulate  the  activity  of  the  organs. 

3  The  chemical  processes  involved  in  the  growth  and  repair  of 
tissue  and  in  the  oxidation  of  material  derived  from  food  which 
provides  the  body  with  heat  and  energy. 

«  The  mouth,  throat,  esophagus,  stomach,  and  intestines. 


Care  of  Children  203 

in  the  stomach  and  intestines.  Even  the  lactic  acid 
in  sour  milk  is  too  irritant  for  infants,  though  it  will 
not  harm  older  children,  provided  the  milk  is  pure. r 

The  action  of  a  baby's  bowels  can  usually  be 
regulated  in  three  or  four  months  if,  as  soon  as  the 
infant  is  a  week  old,  it  is  held  on  a  small  chamber 
at  the  same  hours  each  day,  the  best  times  being 
after  the  first  or  second  morning  feeding  and  a  late 
evening  feeding.  For  the  first  few  times  that  this 
is  done  it  will  probably  be  necessary  to  induce  re- 
latively strong  irritation  by  inserting  a  small  piece 
of  soap  in  the  anus, 2  but,  in  a  day  or  two,  moving 
the  finger  around  the  rectum  ought  to  induce 
enough  irritation  to  produce  the  reflexes  that  cause 
the  rectum  to  expel  its  contents.  Even  this  irrita- 
tion should  be  discontinued  as  soon  as  possible, 
though,  at  first,  this  will  mean  longer  waiting  for 
the  reflexes  to  occur. 

The  skin,  like  the  mucous  membrane,  is  very 
easily  irritated  in  early  childhood  and  thus  rough 

1  The  lactic  acid  is  derived  by  the  disintegration  of  lactose  (the 
sugar  of  milk).  The  change  is  produced  by  certain  bacteria — 
which  are  always  present  in  the  ducts  leading  from  cows'  udders 
and  thus  get  into  the  milk.  These  germs,  however,  are  not  danger- 
ous to  human  beings,  but,  unless  milk  is  kept  out  of  contact  with 
anything  dirty,  it  will  become  infected  with  bacteria  that  dis- 
intergrate  other  constituents  of  the  milk  and  produce  substances 
that  are  very  harmful,  but  do  not  necessarily  change  the  taste  or 
appearance  of  the  milk.  Also,  if  milk  is  not  properly  cared  for,  it 
may  become  contaminated  with  germs  that,  though  they  do  not 
induce  any  changes  in  milk,  will  cause  diseases.  Scarlet  fever, 
typhoid  fever,  and  various  forms  of  dysentery  have  frequently 
been  traced  to  infected  milk. 

1  The  external  opening  of  the  rectum. 


204  Nursing  Methods 

clothing  or  friction  from  any  source  will  cause 
chafing;  and  wind,  the  sun's  rays  and  irritant  sub- 
stances, such  as  impure  soaps,  and  even  pure  soaps 
in  excess,  will  cause  roughening  of  the  skin.  Also, 
for  the  same  reason,  children  are  very  subject  to 
skin  diseases. 

The  special  senses  touch  and  taste  are  already 
developed  when  a  child  is  born  but  a  few  days 
elapse  before  an  infant  appears  to  hear  and  about 
three  weeks  before  its  sight  is  at  all  acute. 

At  birth,  the  skull  is  relatively  large  in  propor- 
tion to  other  parts  of  the  body  and  its  size  increases 
considerably  during  the  first  year  and  then  more 
slowly  up  to  the  seventh  year  when  it  will  have 
nearly  attained  its  full  growth.  During  the  first 
few  months  of  life  the  skull  bones  are  soft  and 
pliable  and  are  not  firmly  united  and,  to  some 
extent,  the  shape  of  the  skull  may  be  modified  by 
the  growth  of  the  brain  but,  later,  development  of 
the  brain  does  not  affect  the  shape  of  the  skull. 

Actual  increase  in  the  size  of  the  brain  ceases 
about  the  same  time  as  the  skull  but  other  physical 
changes  in  its  structure  continue  for  a  varying 
number  of  years.  When  a  child  is  born  the  outer 
part  of  its  cerebrum, x  which  consists  chiefly  of  what 
is  known  as  gray  matter,  is  smooth  but  gradually 

1  The  upper  and  front  portions  of  the  brain.  It  is  this  part  of 
the  brain  that  is  concerned  with  consciousness,  that  instigates 
voluntary  movements  and  perceives  and  interprets  sensations; 
for  example,  our  eye  and  ears  are  merely  the  parts  that  are  stimu- 
lated by  external  influences  but  it  is  because  these  stimuli  are 
transmitted  to  the  brain  that  we  hear  and  see. 


Care  of  Children  205 

ridges  of  various  depths  are  formed.  This  de- 
velopment goes  on  more  slowly  in  the  parts  of  the 
brain  known  as  the  association  areas,  which  are  the 
parts  chiefly  concerned  with  the  higher  mental 
activities  such  as  reasoning,  judgment,  self-control, 
and  will  power.  Other  changes  undoubtedly  go 
on  in  the  brain  from  the  time  of  birth  until  death ; 
changes  which  are  responsible  for  memories,  habits, 
etc.,  but  their  nature  is  almost  entirely  unknown. 

Some   Important  Facts  Regarding  Mental  De- 
velopment 

The  first  signs  of  anything  like  real  mental 
activity  are  observed  when  a  child  is  about  three 
months  old.  Then  a  normal  child  begins  to  hold 
out  its  hands  to  clasp  things  that  attract  its  atten- 
tion— it  is  generally  bright  things  or  those  which 
produce  sound  as  watches  that  do  so.  Shortly 
after  this  it  begins  to  recognize  those  whom  it  sees 
frequently.  When  it  is  about  a  year  old,  it  begins 
to  try  to  talk  and  to  imitate  the  acts  of  others. 
From  the  time  that  it  does  this  its  character  begins 
to  be  formed,  and,  in  some  ways,  what  happens  in 
the  brain  of  a  young  child  in  this  process  and  in  its 
results  may  be  likened  to  the  making1  and  use  of  a 

1  An  unmarked  plate  or  cylinder  is  made  to  revolve  under  a 
stylus  and  the  person  making  the  record  sings  or  speaks,  as  the 
case  may  be,  in  front  of  a  cone-shaped  tube  at  the  bottom  of  which 
there  is  a  membrane,  or  other  appliance,  to  which  the  stylus  is 
attached  and  which  is  vibrated  by  the  waves  made  in  the  air  by 
the  vocal  cords  which  produce  the  voice.  The  stylus  cuts  lines  on 
the  surface  of  the  plate  that  correspond  to  the  vibrations  in  the  air. 


206  Nursing  Methods 

phonograph  record.  In  the  making  of  the  record 
a  smooth,  unmarked  cylinder  or  plate  is  marked 
by  a  stylus  or  needle  with  lines  that  correspond  to 
the  vibrations  in  the  air  produced  by  the  (for 
example)  singer's  voice  and,  when  the  record  thus 
made  is  again  put  under  the  stylus  of  a  phonograph 
and  made  to  revolve  beneath  it  this  stylus,  moving 
in  the  marks  made  by  the  first  one,  will  make  the 
mechanism  to  which  it  is  attached  give  rise  to  the 
same  kinds  of  vibrations  and,  consequently,  sounds 
as  those  by  which  the  lines  were  produced.  Let  the 
cylinder  or  plate  represent  the  child's  brain;  the 
singer,  its  parents,  brothers,  sisters,  and  other  com- 
panions; the  stylus,  the  nerve  impulses  that  these 
arouse.  The  nature  of  the  marks  made  in  the 
brain  are  unknown,  but,  psychologists  consider 
that  anything  which  attracts  a  child's  attention 
(and  thus  arouses  nerve  impulses)  will  leave  an 
indelible  pathway  or  mark,  even  as  the  stylus 
leaves  marks  on  the  phonograph  plate.  After  a 
child  is  about  five  years  old,  any  circumstance  that 
is  very  interesting  or  startling  to  it,  or  sight,  sound, 
act,  or  thought  that  is  frequently  repeated  may 
make  such  a  deep  impression  on  the  brain  that  it 
will  remain  as  a  more  or  less  distinct  memory,  but, 
especially  during  the  earlier  years,  few  marks  do 
this.  Nevertheless,  the  tracing  is  there  and,  just 
as  the  record  reproduces  the  voice  of  the  singer, 
so  the  character  of  a  child  is  a  reproduction  of  the 
marks  made  upon  its  brain  by  its  associates.  How- 
ever, the  results  of  the  marks  on  the  human  record 


Care  of  Children  207 

(the  character)  cannot  be  as  accurately  foretold  as 
in  the  case  of  the  phonograph  record  because  so 
many  people  and  circumstances,  some  good,  some 
bad,  are  concerned  in  the  making  of  the  human  one. 
Also,  the  child's  response  to  the  impressions  make 
a  great  deal  of  difference  in  the  final  results;  if  it 
imitates  what  it  sees  and  hears  the  impressions  in 
the  brain  will  be  deepened1  and  each  repetition  will 
intensify  the  effect  until  the  grooves  become  so 
marked  that  the  nerve  impulses  evoked  by  similar 
thoughts,  sights,  sounds,  etc.,  are  almost  sure  to 
pass  in  them  and  induce  like  responses — i.e.,  to 
make  the  child  think  or  act  as  on  previous  occa- 
sions. It  is  thus  that  habits  are  formed. 

A  pleasing  phonograph  record  can  be  made  by 
a  good  singer,  even  though  there  are  a  few  flaws 
in  the  plate,  though,  of  course  it  will  not  be  perfect, 
but  a  poor  singer  could  not  produce  a  pleasing 
record  on  the  most  perfect  plate.  These  facts,  also, 
are  generally  true  of  the  human  record.  If  the 
protoplasm  of  the  brain  is  poor,  the  best  examples 
and  training  cannot  produce  the  best  possible 
character,  but  those  who  understand  the  natural 
human  instincts  and  how  these  can  be  trained  or, 
on  the  other  hand,  perverted  by  disease  and 
example  can  do  much  toward  overcoming  natural 
or  acquired  deficiencies,  but  poor  training,  unless 

1  The  terms  deepened  and  groove  are  used  because  they  so  ade- 
quately express  the  permanency  of  impression  and  the  difficulty, 
encountered  in  changing  fixed  habits,  but,  as  frequently  stated* 
the  actual  nature  of  the  impressions  is  unknown. 


208  Nursing  Methods 

very  strong  influences  for  good  are  made  by  some 
of  the  child's  associates,  will,  except  in  rarest  in- 
stances, spoil  the  best  inherited  material. 

To  summarize :  A  child's  character  will  depend 
upon:  (i)  The  nature  of  the  brain  protoplasm1 
inherited  from  its  parents ;  (2)  the  degree  of  health 
in  which  this  protoplasm2  is  maintained;  (3)  the 
examples  (good  or  bad)  set  the  child  by  its  asso- 
ciates and  the  nature  of  the  teaching  it  receives; 

(4)  the  degree  to  which  the  child  imitates  the 
examples  of  others  and  the  frequency  of  seeing, 
hearing,  and  doing  the  same  things  in  the  same  way ; 

(5)  the  nature  of  the  things  in  which  an  interest  is 
aroused.    The  characteristics  formed  in  early  life 
can  never  be  entirely  eradicated  for  they  are  the 
results   of   indelible   impressions    through   which 
nerve  impulses  pass  and  control  action  and  thought 
even  as  the  stylus  of  the  phonograph  follows  the 
traces  on  the  record.     Some  of  the  impressions  re- 
main so  vivid  that  we  call  them  memories,  others 
are  so  faint  that  they  never  call  forth  any  definite 
consciousness  but  even  these  subconscious  ones 
are  the  foundation  of  character. 

It  is  the  parts  or  qualities  of  the  cerebmm  that 
govern  the  emotions  (love,  dislike,  etc.),  and  the 
senses  (the  perception  of  things  seen,  heard,  felt, 

1  For  definition  see  page  352. 

3  Poor  circulation  of  blood  in  the  brain,  abnormal  conditions  of 
the  blood,  the  toxins  of  disease  will  all  have  an  injurious  effect 
upon  the  brain,  just  as  they  have  upon  other  organs  of  the  body, 
and  a  diseased,  or  even  a  tired  brain,  cannot  function  properly. 


Care  of  Children  209 

etc.)  that  develop  earliest  in  life.  Also,  the  world 
is  new  to  the  small  child  and  it  is  very  curious  and 
wants  to  know  the  why  and  how  of  everything  and 
its  desire  to  imitate  all  that  it  sees  and  hears  is 
strong. 

After  about  the  sixth  or  seventh  year,  the  parts 
of  the  brain  that  more  especially  control  judgment, 
will  power,  the  faculty  of  associating  ideas  and 
experiences  that  we  call  reasoning  develop  more 
rapidly.  The  degree  to  which  they  will  do  so 
depends  upon  (i)  the  nature  of  the  brain;  (2)  the 
degree  to  which  these  functions  are  exercised;  (3) 
how  soon  the  individual  begins  to  exercise  them. 
For  example :  The  will  power  that  is  necessary  to 
concentrate  the  attention  on  one's  lessons  and, 
later  on  one's  business  or  occupation  will  not  be 
developed  unless  it  is  exerted  to  keep  the  attention 
fixed  when  it  wants  to  wander  and,  if  the  individual 
begins  to  make  such  effort  at  the  age  of  nine  or  ten, 
she  will  have  less  trouble  in  doing  so  than  if  she 
starts  at  fifteen,  and  it  will  be  easier  to  do  it  at 
fifteen  than  at  twenty;  after  twenty,  it  will  be 
almost  impossible  to  attain  the  power  of  concentra- 
tion to  any  great  degree  if  previous  efforts  have 
not  been  successful.  It  is  the  same  thing  with  the 
power  of  reasoning  and  all  other  faculties  necessary 
for  success.  They  must  be  trained  in  youth  if 
they  are  to  be  developed  to  the  individual's  fullest 
capacity.  The  way  to  train  them  and  also  the 
instincts  and  capacities  that  develop  in  early  life 
are  taught  in  psychology. 

'4 


210  Nursing  Methods 

Requirements  for  Health 

The  main  requirements  for  health  are :    i .  All 

the  fresh  air  possible.  In  fine  weather  in  summer, 
a  healthy  baby  can  be  taken  out  of  doors  when 
it  is  a  week  old;  in  cooler  weather,  such  as  is 
common  in  spring  and  fall,  when  it  is  about  a 
month  old ;  in  winter,  when  it  is  about  three  months 
old.  In  fine  weather,  the  longer  children,  even 
infants,  are  out  of  doors  the  better,  but  the  latter 
must  be  protected  from  wind  and  their  eyes  from 
the  sunlight.  The  rooms  in  which  children  live 
must  be  well  ventilated.  This,  it  will  be  remem- 
bered, involves  having  as  free  currents  of  air  as 
possible  without  creating  a  draft.  The  tempera- 
ture of  the  rooms  should  not  be  below  66°  F.  nor 
above  68°  or  69°  F.,  except  when  a  child  is  being 
bathed  when  the  room  should  be  between  73°  and 
77°  F. 

2.  Suitable  clothing.  Children,  especially, 
should  never  wear  tight  clothing  nor  bands.  Any- 
thing tight  around  the  chest  interferes  with  free 
breathing  movements  and  then  the  lower  areas  of 
the  lungs  do  not  expand  as  they  should  and  the 
circulation  of  blood  and  air  through  these  parts  is 
sluggish.  This  diminishes  the  vitality  of  the  cells 
and  they  are  less  able  to  resist  the  action  of  bac- 
teria if  infection  occurs.  Tight  clothing  around 
the  abdomen  may  cause  misplacement  of  the  ab- 
dominal organs  and  interfere  with  the  circulation 
of  blood  through  them.  Tight  garters  inhibit  the 


Care  of  Children  211 

flow  of  venous  blood  from  the  legs  and  predisposes 
to  enlargement  of  portions  of  the  veins  thus  giv- 
ing rise  to  a  condition  known  as  varicose  veins.  In 
infancy  clothing  that  is  too  loose  is  also  to  be 
avoided  because  the  undergarments  are  then  likely 
to  become  creased  and  the  folds  will  irritate  the 
skin.  The  clothing  worn  next  the  skin  should  be  of 
a  nature  (i)  to  absorb  moisture  readily,  and  thus 
prevent  such  rapid  evaporation  of  sweat  that  the 
skin  is  chilled,  and  (2)  to  hold  air  within  its  meshes 
and  thereby  (air  being  a  poor  conductor  of  heat) 
prevent  the  too  rapid  loss  of  heat  from  the  body. 
To  comply  with  these  requirements  the  material 
must  be  loosely  woven  and,  for  the  best  results,  its 
threads  of  a  loose  or  fluffy  nature.  At  one  time 
wool  was  the  only  material  that  complied  well  with 
these  requirements  but  cotton  and  silk  materials 
can  now  be  had  which  are  almost  as  good  and  are 
more  easily  laundried.  The  amount  of  clothing 
put  on  children  while  they  are  too  young  to  know 
when  they  are  too  hot  or  too  cold  is  often  wrong. 
A  prevalent,  but  mistaken,  idea  is  that  children 
should  be  kept  very  warm ;  on  the  other  hand,  some 
people  go  to  the  other  extreme  and  in  order,  so 
they  say,  "to  harden  the  child"  they  clothe  it  too 
lightly.  Both  extremes  may  be  harmful  for  reasons 
given  in  Chapters  I  and  VI.  The  amount  of  cloth- 
ing should  be  regulated  by  the  conditions  of  the 
child's  skin,  this  should  be  slightly  warm  and  dry 
and  not  either  hot  and  moist  or  cold.  What  is 
known  as  the  Gertrude  pattern  is  one  of  the  best  for 


212  Nursing  Methods 

infant's  clothing  because  the  several  pieces  can  be 
put  on  at  the  same  time  and  drawn  up  over  the 
child's  feet  and  there  are  no  bands  to  restrict 
breathing  and  the  circulation.  In  early  infancy 
the  skirts  should  be  long  enough  to  cover,  but  not 
to  drag  upon,  the  feet.  Two  articles  of  infants' 
clothing  that  need  special  attention  are  the  ab- 
dominal binder  and  diapers.  The  binder  was 
formerly  generally  used  until  a  baby  was  at  least 
three  or  four  months  old  in  order  to  support  the 
abdominal  muscles,  but  most  physicians  now 
believe  that,  as  a  rule,  the  binder  is  not  really 
needed  after  the  first  two  weeks  and  that,  unless 
there  is  some  special  reason  for  it,  a  baby  is  better 
without  it,  for,  it  is  quite  a  difficult  matter  to  put 
it  on  tightly  enough  to  support  the  muscles  and 
to  keep  it  from  wrinkling  without  restricting 
breathing.  The  best  kind  of  diapers  to  use  is 
mentioned  on  page  226.  Some  especially  impor- 
tant considerations  in  their  adjustment  and  use 
are  as  follows :  A  diaper  must  never  be  drawn  too 
tightly  around  the  body  nor  be  put  on  in  a  manner 
to  bend  the  child's  legs  nor  keep  them  too  far  apart. 
A  diaper  should  be  changed  as  soon  as  it  is  wet  and 
it  must  not  be  used  again,  even  though  only  wet 
with  urine,  until  it  has  been  washed.  Cheap  soaps 
must  never  be  used  for  washing  diapers  and,  even 
when  pure  soaps  are  used,  diapers  must  be  very 
thoroughly  rinsed  in  clear  water,  for  any  alkali 
remaining  in  the  diapers  is  likely  to  cause  chafing 
of  the  buttocks. 


Care  of  Children  213 

3.  Proper  feeding.  This  is  too  lengthy  a  sub- 
ject to  be  considered  here  in  detail  and  only  a  few 
especially  important  points  will  be  mentioned, 
viz. :  Never  give  a  young  infant  food  that  has  not 
been  prescribed  a  physician,  if  it  is  fed  with  cows' 
or  goats'  milk,  the  proportion  of  the  constituents 
must  be  altered  (according  to  the  doctor's  direc- 
tions) to  resemble  that  of  human  milk.  The  milk 
must  be  kept  in  absolutely  clean  utensils,  to  pre- 
vent its  contamination  with  bacteria,  and  cold,  to 
prevent  the  multiplication  and  activity  of  bacteria 
that  may  be  in  it.  It  is  to  be  realized  that  unless 
milk  is  boiled  it  is  likely  to  contain  some  bacteria, 
even  after  it  has  been  pasteurized,  and,  as  pre- 
viously stated,  boiling  will  destroy  the  vitamines 
which  are  essential  for  a  child's  health.  Exactly 
the  amount  of  food  and  the  number  of  feedings 
ordered  by  a  doctor  are  to  be  given.  Even  after 
infancy,  food  should  not  be  taken  between  meals. 
In  early  youth  and  during  illness,  while  the  quan- 
tity of  food  taken  at  a  time  is  relatively  small,  more 
than  three  meals  a  day  are  required,  but  these 
must  be  given  at  regular  hours  so  that  the  stom- 
ach will  have  time  to  digest  one  meal  and  rest 
before  it  is  given  more  work.  Foods  that  should 
not  be  given  children  until  they  have  attained  the 
stated  ages  are  as  follows :  Until  they  are  fourteen 
years  of  age,  children  should  not  be  given  pies  and 
other  pastry,  highly  spiced  foods  or  drinks,  coffee, 
tea,  cider,  soda  water,  and  other  carbonated  drinks1 

'Most  effervescent  drinks  owe  their  effervescence  to  carbon  dioxide. 


214  Nursing  Methods 

or  alcoholic  drinks  of  any  kind.  Children  under 
seven  years  of  age,  should  not  be  given,  in  addition 
to  the  articles  just  mentioned,  pork,  ham,  sausage, 
salt  fish,  dried  beef,  game,  kidney,  liver,  corn, 
cabbage,  beets,  cucumbers,  raw  vegetables  other 
than  greens,  fried  fish  and  vegetables,  hot  bread, 
griddle  cakes,  nuts;  and  even  after  children  are 
seven  years  of  age,  such  foods  must  be  given  in 
moderation.  Children  between  two  and  four 
years  of  age,  in  addition  to  the  above  articles,  must 
not  be  given  corned  beef,  raw  greens  and  raw  toma- 
toes, sweet  cakes,  bananas,  uncooked  berries  and 
cherries  and  even  other  uncooked  fruits,  except 
their  juices,  must  only  be  given  in  very  small 
amounts,  for  a  considerable  portion  of  their  solid 
material  is  not  digested,  and  is  likely  to  cause 
diarrhea,  because,  as  previously  stated,  a  small 
child's  intestinal  tract  is  very  easily  irritated. 
Fruit  juices,  especially  orange  juice,  are  particu- 
larly good  for  children  because  they  contain  a 
liberal  quantity  of  the  chemical  substances  known 
as  vitamines  which,  as  mentioned  on  page  202,  aid 
metabolism.  Appropriate  diet  for  children. 
Between  twelve  and  fourteen  months : 
6.30  or  7  A.M.,  4  per  cent,  milk,  6  ounces,  diluted 
with  3  ounces  of  well-cooked,  strained  cereal  gruel. 

9  A.M.,  orange  juice, r  one  or  two  ounces. 

10  A.M.,  same  as  6.30  A.M. 

'When  expense  has  to  be  considered,  the  juice  of  canned 
tomatoes  may  sometimes  be  substituted.  Tomatoes,  unlike  other 
vegetables,  do  not  lose  their  vitamines  when  canned. 


Care  of  Children  215 

2  P.M.,  beef  juice,  2  ounces,  or  strained  chicken, 
beef,  or  mutton  broth,  6  ounces.  Well-cooked  and 
strained  cereal  jelly,  about  3  to  4  ounces  with  milk. 

6  and  10  P.M.,  same  as  6.30  A.M. 
Between  fourteen  and  eighteen  months : 

7  A.M.,  milk,  4  per  cent.,  8  ounces. 

9  A.M.,  fruit  juice,  preferably  orange,  about  3 
ounces. 

10.30  A.M.,  unstrained,  but  well-cooked,  cereal, 
about  3  ounces,  with  cream  I  ounce  or  milk  2 
ounces.  A  piece  of  dry  toast  or  rusk  or  zwieback. 
Milk  about  6  ounces. 

2  P.M.,  meat  broth,  about  4  ounces.  Either  a 
small  baked  potato  or  well-cooked  rice  with  a  soft 
cooked  egg.  A  small  piece  of  toast.  Water,  no  milk. 

6  P.M.,  same  as  10.30  omitting  the  toast. 

10  P.M.,  milk,  about  6  ounces. 
Between  eighteen  months  and  two  years : 
This  should  be  the  same  as  the  previous  diet, 

with  the  occasional  substitution  of  finely  minced 
chicken,  beef,  or  white  fish  for  the  egg  in  the  2  P.M. 
meal  and  the  addition  of  a  small  amount  (about 
a  level  tablespoonful)  of  mashed  and  strained 
carrot  or  peas  or  spinach  and  a  dessert  of  either 
custard  or  strained  cooked  prunes  or  apple  sauce. 
Also  stale  bread  or  toast  and  milk  is  added  to  the 
6  P.M.  meal,  and  the  10  P.M.  meal  is  omitted.  Very 
little  sugar  should  be  used  in  cooking  fruit  for 
infants  and  a  little  salt,  but  no  sugar,  should  be 
served  with  the  cereal.  If  a  baby  is  accustomed  to 
eat  things  without  sugar  it  learns  to  like  them  in 


216  Nursing  Methods 

this  way  and  too  much  sugar  is  one  of  the  common 
causes  of  digestive  disturbances  in  childhood. 
Water  should  be  given  between  meals. 

4.  Prevention     of     constipation.     Important 
measures  for  doing  this  are :  Training  the  infant  to 
use  the  chamber  as  described  on  page  203  and,  in 
later  life,  going  to  the  toilet  at  a  regular  hour,  soon 
after  breakfast  being  a  good  time.    Going  to  the 
toilet  as  soon  as  the  desire  to  do  so  is  felt.    Nothing 
is  more  likely  to  produce  constipation  than  failure 
to  do  this  for,  though  defecation  is  to  some  extent 
under  voluntary  control,  the  actual  act  is  a  reflex 
one  produced  by  nerve  impulses  that  are  aroused 
by  irritation  of  the  rectum  by  material  entering 
it  from  the  upper  part  of  the  bowel  and  this  reflex 
becomes  less  prompt  and  powerful  if  it  is  con- 
stantly interfered  with  by  conscious  effort,  as  when 
one  resists  the  desire  to  go  to  the  toilet.    If  further 
treatment  is  needed  for  infants,  a  doctor  should 
be  consulted,  older  children  and  adults  should  eat 
fruit,  coarse  cereals,  and  vegetables,  and  take  all 
the  exercise  possible.    Constipation  is  very  harm- 
ful because  when  food  residue  stays  too  long  in  the 
intestine  it  is  decomposed  by  bacteria  into  sub- 
stances that  may  be  very  harmful  to  the  body. 

5.  Training  the  body  to  react  to  differences  in 
temperature  as  described  in  Chapter  VI  and  on 
page  221. 

6.  Freedom  from  irritating  conditions  such  as 
are  induced  by  adenoids,   eyestrain,  and  other 
remedial  body  defects. 


Care  of  Children  217 

7.  Care   against   infection   by   bacteria.     To 
avoid  the  contracting  or  causing  infections  children 
should  be  taught  to  observe  the  following  pre- 
cautions: Not  to  spit  on  the  ground;  to  hold  a 
handkerchief  in  front  of  the  face  when  sneezing 
or  coughing;  not  to  use  public  drinking-cups  or 
towels ;  not  to  touch  the  spout  of  a  drinking-foun- 
tain  when  taking  a  drink;  not  to  wet  the  fingers 
in  the  mouth  before  turning  the  leaves  of  a  book; 
not  to  put  the  fingers,  money,  or  any  unnecessary 
article  in  the  mouth ;  not  to  take  a  bite  of  another 
child's  candy,  etc. ;  not  to  eat  anything  that  looks 
dirty  or  upon  which  flies  have  been  seen  to  alight ; 
to  wash  food  and  raw  vegetables  before  eating  them. 

8.  Sufficient  rest  and  sufficient  exercise.    Exer- 
cise is  of  primary  importance  for  maintaining  nor- 
mal muscle  tone  and  circulation  of  the  blood. 
Therefore,  as  previously  stated  an  infant's  clothing 
and  surroundings  must  not  be  allowed  to  interfere 
with  its  movements.    A  certain  amount  of  crying, 
about  thirty  or  forty  minutes  a  day,  is  good  for  a 
baby,  it  exercises  its  lungs  and  other  parts  of  its 
breathing  apparatus.    The  cry  of  a  healthy  baby 
will  be  loud  and  strong.     When  a  baby  cries  it 
should  not  be  petted  and  taken  up  or  it  will  form 
the  habit  of  crying  and  do  so  more  than  it  ought  to. 
If  it  cries  too  long  or  frequently  means  should  be 
taken  to  ascertain  the  cause. 

The  nature  of  a  child's  cry  often  gives  some  clue 
to  its  cause,  for  example,  if  the  child  is  in  pain,  the 
cry  is  sharp  and  is  usually  accompanied  with  draw- 


2i8  Nursing  Methods 

ing  up  of  the  legs  and  distortion  of  the  features ;  a 
fretful,  moaning  cry,  indicates  illness;  a  strong 
fretful  cry  accompanied  with  sucking  of  the  fingers 
usually  indicates  hunger;  but,  if  it  is  not  time  for  a 
feeding  the  child  should  not  be  indulged .  If  it  is  fre- 
quently hungry,  however,  the  doctor's  advice  should 
be  sought  as  it  may  not  be  getting  enough  food. 

If  a  child  is  fretful  and  does  not  sleep  properly 
or  shows  other  signs  of  distress  it  is  well  to  take  its 
temperature  and  an  infant's  temperature  is  best 
taken  by  rectum.  The  means  of  doing  this  can 
not  be  demonstrated  in  class  but,  if  the  method  of 
taking  it  by  mouth  is  known,  the  following  instruc- 
tions can  be  easily  followed : 

Shake  down  the  mercury,  lubricate  the  bulb 
with  vaseline,  insert  it  gently  in  the  rectum  for 
about  one  inch  pointing  it,  if  the  child  is  lying  on 
its  back,  slightly  backward  and,  if  it  is  lying  face 
downward,  slightly  forward.  Hold  the  thermo- 
meter in  place  for  three  minutes.  Fig.  45  shows 
the  way  in  which  a  child  is  usually  held  when 
taking  its  temperature  as,  when  it  is  in  this  posi- 
tion, its  movements  are  easily  restrained. 

Demonstration  22 
Lifting,  Weighing,  Bathing,  and  Dressing  a  Baby1 

Equipment:  I.     A  large  doll  in  a  crib. 
2.     Scales. 

1  This  description  is  for  a  baby  over  two  weeks  old.  An  infant 
younger  than  this  should  be  bathed  by  a  nurse  or,  if  this  is  im- 
possible, following  the  directions  of  a  doctor  or  nurse. 


Care  of  Children  219 

3.  A   wrap,    a   square    (about   one   yard)    of 
flannelet  is  a  good  kind. 

4.  Two  soft  warmed  towels. 

5.  A  rubber  apron. 

6.  A  bath  thermometer. 

7.  A  small  tub  about  two  thirds  full  of  water 
with  temperature  of,  at  the  time  of  use : 

For  an  infant  under  three  months 95°  to  100°  F. 

For  an  infant  three  months  and  upward. .  90°  to    96*  F. 

For  an  infant  one  year 85°  to    90°  F. 

For  an  infant  two  years 75°  to    80°  F. 

8.  Soap  or,  better,  a  small  basin  of  hot  soap- 
suds.   Only  the  purest  unscented  soap,  such  as  Cas- 
tile, should  be  used,  cheap  soaps  and  cold  process 
glycerine  soaps  are  likely  to  contain  free  alkali  which 
irritates  a  baby's  skin. 

9.  Pure  unscented  toilet  powder  in  a  can  with 
a  perforated  cover.     Powder  puffs  should  never  be 
used. 

10.  Clothing1  consisting  of:    A  binder   (this 
should  be  used  in  class  in  order  to  learn  how  to  put 
one  on  though,  as  previously  stated,  binders  are  not 
generally  used  after  a  child  is  about  two  weeks  old) 
a  shirt,  a  flannel  petticoat,  except  in  warm  weather; 
a  white  petticoat,  if  desired;  a  dress;  stockings; 
diapers,  a  small  one  of  stockinet  (about  fourteen 
inches  square  for  a  small  baby)  and  a  larger  one 
(about  half  to  three  quarters  of  a  yard  square)  of 
heavier  material,  for  example,  Canton  flannel. 

1  To  the  Teacher:     It  is  well  to  have  samples  of  good  and  poor 
styles  of  clothing  to  show  the  pupils. 


220  Nursing  Methods 

11.  Safety  pins. 

12.  Scissors,  needle,  thread,  and  thimble. 
Points  of  special  importance  to  remember  when 

lifting,  weighing,  bathing,  and  dressing  a  baby: 

Do  not  startle  an  infant  by  lifting  it  quickly  and 
suddenly  when  it  is  asleep. 

Do  not  undress  a  baby  in  a  room  colder  than 
about  75°  F. 

Always  support  a  young  baby's  neck  and  back 
while  lifting  and  holding  it. 

If  possible  weigh  a  baby  about  once  a  week  for 
the  weight  is,  as  a  rule  a  good  index  of  its  condition. 

Formerly  it  was  thought  that  the  baby  should  not 
be  exposed  while  being  weighed  and  bathed,  but  it 
is  now  believed  that,  if  the  room  is  about  75°  F. 
and  the  baby  is  healthy,  it  is  well  to  expose  the 
body  to  the  air  for  a  short  time,  but  a  wrap  should 
be  put  about  the  baby  after  it  is  undressed  and, 
though  it  may  be  thrown  back  while  the  child  is 
in  the  scales  and  being  bathed,  etc.,  it  must  be  kept 
where  it  can  be  drawn  about  the  baby  if  the  latter 
appears  cold.  The  weight  of  a  wrap  that  is  about 
a  baby  while  it  is  being  weighed  must  be  ascer- 
tained and  deducted  from  the  total  weight. 

Keep  the  tub  used  for  bathing  an  infant  exclu- 
sively for  that  purpose. 

Have  the  temperature  of  the  water  correct. 
To  have  it  unnecessarily  hot  is  bad  for  a  child  for 
reasons  given  in  Chapter  VI,  and  temperatures 
lower  than  those  mentioned  on  page  219  for  the 
given  ages  may  also  be  harmful  because  a  small 


Care  of  Children  221 

child's  system  will  not  have  been  trained  to  react 
to  cold.  After  a  child  is  about  two  or  three  years 
old  it  is  well  to  complete  the  bath  with  a  spray  of 
cold  water — about  7o°-65°  F.  While  using  the 
spray  have  the  child  stand  in  water  about  80°  F. 
and,  for  the  first  few  times  spray  only  part  of  the 
body  for  a  minute  or  two  and  do  it  in  a  manner  to 
amuse  the  baby,  for  if  a  child  is  frightened  or  al- 
lowed to  feel  cold,  it  is  likely  to  dread  the  spray 
and  cold  baths,  which  is  to  be  deplored,  because, 
for  reasons  given  on  page  95,  they  are  a  great  help 
in  maintaining  good  health.  Having  a  floating  toy 
or  two  in  the  bath  water  is  a  help  in  making  a  child 
enjoy  its  baths. 

While  bathing  a  baby  notice  its  general  condi- 
tion, look  especially  for  signs  of  chafing  and  at  the 
condition  of  the  eyes  and  mouth.  Formerly  it  was 
customary  to  wash  the  eyes  and  mouth  with  boric 
acid  solution,  but  now,  most  physicians  consider 
this  not  only  unnecessary,  but  injurious  and  be- 
lieve that,  when  these  organs  are  in  a  normal  condi- 
tion, washing  around  the  eyes  with  a  clean  wash 
cloth  and  warm  water  when  washing  the  face  is  all 
the  cleansing  that  the  eyes  require  and  that  the 
mouth  seldom,  if  ever,  needs  any  cleaning  until  the 
teeth  appear.  Of  course  if  a  baby  has  fever  or 
digestive  disturbances,  just  as  in  the  case  of  an 
adult,  the  mouth  will  become  dry  and  coated,  and 
if  anything  unclean,  for  example  a  soiled  bottle 
nipple,  is  put  in  a  baby's  mouth  a  condition  known 
as  thrush  is  likely  to  develop.  Thrush  is  caused 


222  Nursing  Methods 

by  a  very  prevalent  microorganism  that  multiplies 
rapidly  in  decomposing  milk  and  sugar  substances. 
The  first  signs  of  the  infection  are  white  specks  in 
the  mouth  and  increased  redness  of  the  membrane. 
In  such  cases  the  mouth  must  be  washed  often 
enough  to  keep  it  clean,  but  a  doctor's  advice 
should  be  sought. 

Observe  the  following  precautions  when  wash- 
ing a  child's  mouth :  Wash  your  hands  thoroughly. 
Use  only  clean,  soft  material,  such  as  absorbent 
cotton  (gauze  is  too  rough).  Do  not  make  this 
moist  enough  for  the  liquid  to  be  swallowed  for 
even  though  this  is  not  poisonous  it  is  very  un- 
desirable for  material  from  an  infected  mouth  to 
enter  the  stomach.  Use  the  utmost  gentleness 
when  washing  the  mouth  for  more  than  the 
slightest  degree  of  rubbing  is  likely  to  break  the 
surface  of  the  membrane  and  a  very  serious  deep 
infection  may  follow.  Very  frequently  all  that  is 
required  to  clean  the  interior  of  the  mouth  is  to 
put  a  wad  of  moistened  cotton  in  the  mouth  and 
the  sucking  movements  that  the  child  then  makes 
will  cause  sufficient  rubbing.  To  clean  the  interior 
of  the  cheeks,  outer  border  of  the  gums  and,  if 
necessary,  within  the  mouth,  wind  a  piece  of  cotton 
around  one  end  of  a  thin  strip  of  whalebone,  as  di- 
rected in  Chapter  IV,  or  your  little  finger.  Moisten 
the  cotton  and  move  it  about  the  mouth  very,  very 
gently.  Change  the  cotton  as  often  as  necessary,  do 
not  reinsert  a  soiled  piece  in  the  mouth.  Though  the 
washing  is  to  be  done  gently,  it  must  be  thorough. 


FI£-  45-     Position  in  which  to  hold  an  infant  when  taking 
its  temperature. 


Care  of  Children  223 

When  dressing  a  baby  do  not  put  any  safety 
pins,  knots,  or  buttons  where  the  child  will  lie  upon 
them  and  use  as  few  of  such  things  as  possible. 
Never  put  a  straight  pin  in  a  child's  clothing  and 
use  safety  pins  only  for  the  diapers. 

Procedures:  See  that  the  temperature  of  the 
room  is  about  75°  F. 

Arrange  the  scales  and  articles  required  for  the 
bath  and  dressing  where  you  can  reach  them  easily. 
If  the  weather  is  cold  have  them  near  a  radiator 
if  possible  and  hang  the  wrap  and  towels  on  this 
that  they  may  be  warmed. 

Weigh  the  wrap. 

Put  on  your  apron ;  take  the  weighed  wrap  and 
lifting  the  baby  gently,  so  as  not  to  startle  it,  put 
the  wrap1  around  it  with  the  opening  on  the  side 
that  will  be  nearest  you  when  you  sit  with  the 
baby  on  your  lap. 

Undress  the  baby.  While  doing  so  sit  with  it 
lying  in  your  lap  and  draw  its  clothing  off  over  its 
feet. 

Put  the  wrap  in  the  scales  and  the  baby  on  the 
wrap  and  note  the  weight.  Deduct  the  weight  of 
the  wrap  from  the  total. 

Hold  the  baby  in  your  lap  with  one  side  of  the 
wrap  covering  your  apron  and  the  other  ready  to 
be  drawn  around  the  child  if  necessary. 

See  that  the  temperature  of  the  bath  water  is 
accurate. 

1  The  wrap  is  put  around  the  baby  so  that  when  it  is  undressed 
it  will  not  come  in  contact  with  your  rubber  apron. 


224  Nursing  Methods 

Proceed  with  the  bath.  An  infant  may  be 
bathed  in  the  lap  or  sprayed  or,  after  it  is  three 
weeks  old,  a  healthy  infant  may  be  put  into  a  small 
tub.  As  previously  stated,  it  is  rarely  necessary 
to  use  soap  more  than  once  a  week.  Wash  first 
the  face,  head,  and  neck  and  then  in  turn  the  arms, 
chest,  legs,  back,  buttocks,  and  between  the  legs. 
Pay  particular  attention  to  the  eyelids,  ears,  but- 
tocks and  all  parts  where  two  surfaces  of  skin  come 
together.  When  bathing  a  baby  in  your  lap,  dry 
each  part  before  proceeding  to  another  and,  when 
the  bath  is  completed,  draw  the  wrap  around  the 
child  and  by  gently  rubbing  over  the  former  make 
sure  that  there  is  no  moisture  on  the  body.  Then 
put  your  left  arm  under  the  wrap  in  a  manner  to 
adequately  support  the  baby,  draw  the  dry  warm 
towel  over  your  lap,  discard  the  wrap  and  put  the 
baby  down  on  the  towel.  When  putting  a  baby 
into  a  tub  bath,  have  your  left  wrist  and  hand  under 
its  head  and  shoulders  with  your  thumb  and  little 
finger  extending  into  the  axillae.  Hold  the  legs 
with  your  right  hand.  Keep  your  left  hand  in  the 
same  position  during  the  bath  and  wash  with  your 
right  hand.  Do  not  keep  the  baby  in  the  tub  more 
than  two  or  three  minutes.  To  lift  it,  take  hold  of 
the  legs  in  the  same  manner  as  when  putting  it  into 
the  tub ;  raise  it  from  the  water  and  hold  it  for  a 
second  or  two  above  the  tub,  then  put  it  on  your 
lap  and  bring  the  wrap  around  it ;  dry  it  by  gently 
patting  over  the  latter  and  with  one  of  the  warm 
towels.  Then  replace  the  wrap  with  a  dry  towel 


Care  of  Children  225 

as  when  giving  the  bath  in  the  lap.  The  method  of 
giving  a  spray  bath  is  so  dependent  upon  the  kind 
of  apparatus  used  that  no  adequate  description 
can  be  given. 

Powder  the  baby  if  necessary.  To  do  so,  shake 
a  little  over  the  parts  where  it  is  required  and  then 
rub  it  gently  with  your  hand.  The  powder  is  used 
to  dry  the  skin  and  thus  prevent  chafing  and, 
except  in  hot  weather,  all  that  is  usually  required 
is  a  little  between  the  buttocks,  in  the  groins  and 
axillae  and  some  babies  do  not  even  need  this  much. 

Dress  the  baby:  If  a  binder  is  to  be  used1  put 
it  around  the  abdomen,  draw  it  firmly  enough  to 
keep  it  from  wrinkling,  but  not  so  tightly  that  it 
will  interfere  with  breathing.  Sew  it  in  front  with 
coarse  thread. 

Put  the  shirt  on ;  if  it  is  closed,  draw  it  upward 
over  the  feet.  To  get  the  child's  arms  into  the 
sleeves,  put  the  fingers  of  your  right  hand  up 
through  a  sleeve  and,  taking  hold  of  the  child's 
hand,  draw  its  arm  down  through  the  sleeve. 

Fold  a  small  diaper  cornerwise,  place  it  under 
the  child's  buttocks  with  the  longest  side  at  the 
waistline,  bring  the  three  corners  together  in  front 
and  pin  them  with  as  small  a  safety  pin  as  can  be 
used  conveniently.  Fold  a  large  diaper  in  the 
same  manner  as  the  small  one,  pin  it  around 
the  waist  and,  with  the  small  one,  to  the  tab  on 
the  shirt  that  is  intended  for  the  purpose.  Do  not 

1  The  objections  to  its  use  when  not  needed  were  mentioned 
on  page  212. 

IS 


226  Nursing  Methods 

bring  the  ends  of  the  large  diaper  up  between  the 
legs. 

If  possible  arrange  the  remainder  of  the  garments 
one  inside  the  other  so  that  they  can  be  put  on  at 


Fig.  46.     Shape  of  folded  diaper. 

the  same  time.  Draw  them  up  over  the  legs  and 
draw  the  arms  into  the  sleeves  in  the  manner  de- 
scribed for  the  shirt. 

Demonstration  23 

Preparation  of  an  Infant's  Food.    Care  of  Bottles, 
Nipples,  and  Other  Utensils 

Articles  required :  I .     Two  bottles  of  4  per  cent. 
milk.1 

2.  A  prong  for  removing  the  cover. 

3.  Nursing  bottles.     The  standard  graduated 
Hygeia  nursing  bottle  is  the  best  type,  for  it  can  be 
easily  cleaned.    There  should  be  a  bottle  for  each 
feeding  that  the  baby  is  to  have  in  the  twenty- 
four  hours. 

1  Milk  containing  4  per  cent.  fat.    This  is  the  amount  usually 
contained  in  good  cow's  milk  in  temperate  climates. 


Care  of  Children 


227 


4.  A  basket  with  a  handle  in  which  to  stand  the 
bottle.    There  are  special  wire  baskets  to  be  had 
for  this  purpose,  but  a  wicker  one 

that  has  fairly  straight  sides  will 
answer  or,  if  the  milk  is  not  to  be 
pasteurized,  a  deep  dish  or  bowl  can 
be  substituted. 

5.  A  granite  pot  large  enough  to 
hold  the  basket  of  bottles. 

6.  Absorbent  cotton   or   rubber 
corks1  to  fit  the  nursing  bottles. 

7.  A  Chapin  dipper. 

8.  An  enamel  quart  pitcher. 

9.  A  thirty -two  ounce  graduated 
glass  measure  or,  if  this  cannot  be 
obtained  a  small  measure  and  an 
extra  enamel  pitcher. 

10.  A  teaspoon. 

11.  A  glass  rod2  about  two  inches  longer  than 
the  glass  measure. 

12.  A  funnel  to  fit  the  nursing  bottles. 

13.  A  dairy  thermometer,  if  the  milk  is  to  be 
pasteurized. 

1  Ordinary  corks  are  so  porous  that  germs  can  pass  through 
them.  Sterile  absorbent  cotton  makes  the  best  stopper  but  is 
expensive  and  rubber  corks  answer  the  purpose  if  they  are  washed 
and  boiled  daily. 

3  A  glass  rod  is  better  than  a  spoon  for  stirring  the  milk  mixture 
because  a  spoon  that  has  a  small  enough  bowl  to  fit  into  the 
measure  will  not  have  a  long  enough  handle  to  make  it  unneces- 
sary for  the  hand  to  be  within  the  circumference  of  the  measure. 
Such  rods  are  inexpensive  and  can  be  bought  at  almost  any  drug 
store. 


Fig.  47.     Ideal 
nursing  bottle. 


228  Nursing  Methods 

14.  Some  sugar,  either  cane  sugar  or  lactose.1 

15.  A    pitcher    of    boiled    water    or    cereal 
water. 2 

1 6.  Boracic  acid  powder. 

17.  Nipples,  preferably  one  for  each  bottle.3 

1 8.  A  small  saucepan  and  2  small  covered  jars 
for  the  nipples. 

19.  A  clean  apron. 

20.  A  piece  of  clean  white  oilcloth  such  as  is 
used  for  covering  tables,  or,  if  this  cannot  be  ob- 
tained, a  clean  towel. 

21.  Two  clean  towels. 


1  Lactose  is  the  natural  sugar  of  milk  and  is  prepared  from  it — 
it  is  not  as  heavy  as  granulated  cane  sugar,  two  tablespoonfuls 
of  cane  sugar  and  three  of  lactose  weighing  an  ounce.  This  differ- 
ence in  weight  must  be  remembered  if  necessary  to  substitute  one 
sugar  for  another  when  preparing  a  feeding. 

3  Specially  prepared  flours  are  generally  used  for  making  cereal 
waters  for  infants,  as,  if  the  untreated  grains  are  used  they  must 
be  cooked  for  from  three  to  six  hours,  the  reasons  for  this  were 
mentioned  on  page  202.  To  prepare  a  cereal  water,  make  the 
amount  of  flour  prescribed  into  a  paste  with  a  little  cold  water 
then,  add  (slowly  to  prevent  lumping)  the  amount  of  boiling  water 
required,  stirring  the  mixture  constantly  as  you  do  so.  Cook  this 
in  a  double  boiler  the  length  of  time  specified;  it  will  be  necessary 
to  stir  it  constantly  for  a  short  time  and  occasionally  afterward. 
If  the  amount  is  reduced  during  cooking,  add  enough  boiling  water 
to  replace  that  lost,  e.g.,  if  the  doctor  told  you  to  use  two  table- 
spoons of  flour  to  a  quart  of  water,  if  there  is  less  than  a  quart  of 
cereal  water  at  the  completion  of  cooking,  add  enough  boiling 
water  to  make  this  amount,  otherwise,  there  will  be  more  flour 
in  the  water  than  the  doctor  intended  and  it  may  be  more  than 
the  baby  can  assimilate. 

3  The  reason  for  this  is  that  there  is  likely  to  be  lack  of  care  in 
the  cleaning  of  a  nipple  when  it  has  to  be  done  after  each  feeding. 


Care  of  Children  229 

22.  A  bottle-brush,  for  cleaning  the  bottles, 
and  a  small  hand-brush  for  cleaning  the  nipples. 

Points  of  special  importance  in  Q 

connection  with  an  infant's  feed- 
ing: A  young  baby  should  not 
be  given  any  food  that  has  not 
been  prescribed  by  a  doctor. 

In  preparing  the  food,  the  mea- 
surements must  be  absolutely 
correct. 

Fig.  48.     Brush  for 

Everything  used  for  the  prepara-      cleaning  bottles. 
tion  must  be  perfectly  clean. 

The  milk  should  be  kept  in  the  same  compart- 
ment as  the  ice  and  surrounded  by  the  latter, 
nothing  else  should  be  placed  near  it.  If  there  is 
not  ice,  each  bottle  should  be  rolled  in  a  layer  of 
wet  cheesecloth  and  stood  in  a  pan  containing 
water  and  this  placed  in  a  draft. 

If  the  milk  is  not  certified  or  pasteurized '  when 
obtained — it  should  be  pasteurized  after  it  is  pre- 
pared and,  after  this  is  done,  it  must  be  cooled 
rapidly. 2 

1  Milk  obtained  from  dairies  that  are  under  the  supervision  of 
the  Board  of  Health  and  comply  with  certain  rules  made  by  the 
Board  which  gives  them  the  right  to  label  their  milk  "Certified." 

1  So-called  after  Pasteur  one  of  the  first  bacteriologists  to  show 
that  spoiling  of  food  was  due  to  microorganisms.  Pasteurizing 
milk  differs  from  sterilizing  it  in  that  the  milk  is  exposed  to  a 
lower  degree  of  temperature  and  for  a  shorter  time  when  it  is 
pasteurized  than  when  it  is  sterilized,  and  thus  fewer  changes  are 
caused  in  the  milk,  but,  though  most  of  the  bacteria  likely  to 
oe  in  the  milk  are  killed  by  the  lower  temperature,  what  are  known 
as  spores,  are  not  and  these,  if  the  milk  remains  warm,  will  de- 


230  Nursing  Methods 

Fresh  food  must  be  prepared  each  day. 

The  food  for  each  feeding  should  be  placed  in  a 
separate  bottle  and,  if  any  is  left,  it  should  be 
thrown  away.  Occasionally,  even  when  the  baby, 
food,  and  nipple  are  all  right,  a  baby  will  not  take 
the  whole  of  a  feeding,  but  when  this  happens  it 
should  be  ascertained  if  there  is  any  avoidable 
cause;  two  common  ones  are:  (i)  too  small  a  hole 
in  the  nipple ;  (2)  the  baby  sleeps  while  it  is  being 
fed. 

Bottles  and  nipples  should  be  rinsed  in  (i)  cold 
water1;  (2)  hot  water  as  soon  as  they  have  been 
used.  Each  bottle  should  be  kept  filled  with  water 
until  it  is  cleansed.  It  is  well  to  clean  all  the  bottles 
at  the  same  time  and,  as  they  should  be  cold  when 
the  milk  is  put  into  them,  this  is  best  done  in  the 
evening,  if,  as  it  usually  should  be,  the  milk  is 
prepared  in  the  morning.  However,  some  people, 
for  convenience,  prefer  to  have  two  sets  of  bottles 
so  that  those  used  one  day  can  be  cleansed  at  the 
same  time  as  the  utensils  used  for  the  preparation 
of  the  milk.  The  bottles  should  be  washed  in  hot 
soapsuds,  using  a  brush,  and  then  very  thoroughly 


velop  into  bacteria.  Milk  is  a  particularly  favorable  food  for 
bacteria  and  they  develop  very  rapidly  in  it  unless  the  milk  is 
kept  at  a  temperature  that  is  unfavorable  for  them,  i.e.,  below 
50°  F. 

1  Milk  contains  a  substance  called  albumin  which  is  coagulated 
by  heat  and,  if  hot  water  is  used  before  all  trace  of  the  milk  is 
removed,  this  makes  the  glass  look  smeared  and  it  is  difficult  to 
remove. 


Care  of  Children  231 

rinsed  and  scalded  with  hot  water.  T  They  should 
then  be  inverted  in  the  basket  or  a  bowl  so  that 
they  will  drain,  and  this  stood  in  the  pot  and 
covered.  Sometimes,  especially  in  summer  time, 
it  is  well  to  boil  the  bottles.  To  do  this,  fill  the  pot 
sufficiently  to  cover  the  bottles  with  cold  water2 
and  let  this  come  slowly  to  boiling  point  and 
boil  for  at  least  five  minutes.  Let  the  water 
cool  and  then  pour  it  off  and  invert  the  bottles 
to  drain. 

It  is  well,  if  possible,  to  have  as  many  nipples  as 
bottles  and  to  rinse  each  nipple  after  use  in  (i)  cold 
and  (2)  hot  water  and  then  drop  it  into  a  covered 
jar  and  wash  the  entire  supply  when  washing  the 
bottles.  Wash  them  with  a  brush  using  first 
soapsuds  and  then  hot  water.  Wash  both  sides 
of  the  nipples.  To  turn  a  nipple,  put  the  end  of 
your  finger  against  the  point  of  the  nipple,  push  it 
upward  and,  at  the  same  time,  turn  the  open  end  of 
the  nipple  down  over  your  finger.  After  they  are 
washed,  tie  the  nipples  in  a  square  of  cheesecloth 
and  boil  them  for  a  minute — have  the  water  boil- 
ing before  you  put  the  nipples  in  and  do  not  boil 

1  Always  let  the  hot  water  run  over  as  well  as  into  the  bottles  so 
that  all  parts  of  the  glass  will  be  expanded  at  the  same  time  by 
the  heat  and  then  the  glass  will  not  break. 

2  If  the  bottles  are  not  in  a  basket  something  such  as  a  piece  of 
wood  or  a  folded  towel  should  be  placed  between  them  and  the 
metal,  because  metal  does  not  expand  as  readily  as  glass  under  the 
influence  of  heat  and  it  absorbs  heat  more  rapidly  than  glass  and 
for  these  reasons,  it  is  likely  to  crack  the  bottles  if  it  touches 
them. 


232  Nursing  Methods 

them  longer  than  necessary,  as  the  heat  softens 
the  rubber.  Pour  off  the  water  at  once,  expose  the 
nipple  to  the  air  for  a  few  minutes  (in  the  pan  in 
which  they  were  boiled)  that  they  may  dry  and 
then  empty  them  into  a  dry  jar  that  has  been 
boiled  and  can  be  tightly  covered.  After  they 
have  been  boiled  the  nipples  must  not  come  in 
contact  with  anything  but  the  pan  in  which  they 
were  boiled  and  the  sterile  jar. 

If  there  is  only  one  nipple  for  use,  wash  it  at 
once  after  use  and  drop  it  into  the  solution.  Boil 
it  once  a  day. 

If  rubber  corks  are  used  boil  them  at  the  same 
time  as  the  nipples. 

Especially  important  points  to  remember  re- 
garding the  care  of  nipples  are :  Always  wash  both 
sides  of  a  nipple. 

After  a  nipple  has  been  washed  do  not  touch  the 
part  that  is  to  go  in  the  baby's  mouth. 

Always  keep  at  least  one  new  nipple  in  the  house, 
for  the  hole  in  a  nipple  may  become  enlarged  during 
the  cleansing. 

Reason  for  and  nature  of  the  modification  of 
milk  for  infants :  The  milk  of  each  species  of  animal 
is  suited  to  the  requirements  and  digestive  capaci- 
ties of  its  young  and,  as  the  young  of  the  lower 
species  of  mammalia  grow  more  rapidly  than  the 
human  infant,  the  milks  of  these  species  contain 
more  solid  matter  than  human  milk;  also,  there  is 
some  difference  in  the  proportion  of  the  various 
solids  as  can  be  seen  in  the  following  table : 


Care  of  Children  233 

DIFFERENCES  BETWEEN  HUMAN  AND  Cow's  MILK 

Human  Milk  Cow's  Milk 

Protein,1        i  to    2  per  cent.  4      percent. 

Fat,               3  "    4    "     "  3  to   4      "     " 

Lactose,'       6  "    7    "    "  4.5    "     " 

Mineral,         i   "    2    "    "  .7    "     " 

Water,         87  "88    "     "  86  to  87       "     " 

It  is  because  of  these  differences  that  milk  ob- 
tained from  cows  or  other  animals  has  to  be  modi- 
fied3 before  it  is  given  to  a  young  infant. 

The  modification  of  milk  generally  consists  in 
the  addition  of  water  and  carbohydrate4  and  some- 
times lime  water, s  and,  for  some  infants,  changing 
the  relative  proportion  of  protein  and  fat. 

The  carbohydrates  generally  added  to  milk  are 

1  There  are  a  variety  of  substances  in  foods  that  contain  nitro- 
gen and  are  classed  as  proteins.  Two  kinds  found  in  milk  are 
albumin  (this  is  coagulated  by  heat  and  appears  as  a  scum  on  the 
top  of  milk  when  it  is  heated)  and  caseinogen  (this  is  curded  by 
acid  and  rennin). 

a  The  sugar  in  milk. 

3  Changing  the  proportions  of  the  constituents  of  milk  from  the 
lower  animals  to  resemble  those  of  human  milk  is  termed  modi- 
fication. There  are  however  other  differences  between  the  milks 
that  cannot  be  altered;  two  important  ones  are:  (i)  if  a  child  is 
nursed  it  receives  sterile  milk,  but  other  milk  will  only  be  sterile 
if  raised  to  a  temperature  that  causes  other  changes  in  it;  (2) 
human  milk  is  likely  to  contain  substances  that  protect  the  infant 
from  infection  by  bacteria. 

«  The  principal  foods  classed  as  carbohydrates  are:  Starches, 
sugars,  cellulose  (*'.  e.,  the  fibrous  portion  of  fruit,  vegetables,  and 
other  parts  of  plant)  gums. 

sLime  water  inhibits  the  formation  of  hard  curds  in  the 
stomach  and  increases  the  body's  supply  of  calcium,  but  it  also 
tends  to  retard  digestion  in  the  stomach  and,  therefore,  it  should 
not  be  used  unless  ordered  by  the  doctor. 


234  Nursing  Methods 

either  lactose  or  granulated  sugar,  and  specially 
prepared  starch  in  the  form  of  cereal  water.  As 
previously  mentioned  starch  that  is  subjected  to  a 
high  temperature  or  the  action  of  certain  ferments 
will  undergo  the  same  changes  as  those  induced  by 
digestion. 

The  change  in  the  relative  proportions  of  protein 
and  fat  is  generally  procured  in  either  of  two  ways : 
(i)  cream  is  added  to  whole  milk1 ;  (2)  the  milk  is 
allowed  to  stand  until  the  cream  rises  to  the  top 
and  then  the  number  of  ounces  specified  by  the 
doctor  are  removed.  The  smaller  the  amount  of 
so-called  top-milk  removed,  the  more  fat  and  less 
protein  will  it  contain  because  it  is  principally  the 
fat  of  milk  that  rises  to  the  top. 2  For  examples,  if 
you  take  the  upper  nine  ounces  from  a  bottle  of 
4  per  cent,  milk  that  has  stood  long  enough  for  the 
cream  to  rise  it  will  contain  11.5  per  cent,  fat  and 
approximately  3.0  per  cent,  protein;  while  if  you 
remove  16  ounces  you  will  have  a  top-milk  con- 
taining 7  per  cent,  fat  and  approximately  3.2  per 
cent,  protein. 

The  easiest  accurate  way  to  remove  cream  from 
a  bottle  of  milk  is  with  a  Chapin  dipper  (see  Fig. 
49).  This  can  be  bought  at  almost  any  drug  store. 
The  method  of  using  it  is  described  later. 

Care  in  the  feeding  of  an  infant  is  as  important 
as  care  in  the  preparation  of  its  food. 

1  Milk  from  which  none  of  the  constituents  have  been  removed. 
a  Milk  containing  4  per  cent.  fat.    This  is  the  usual  fat  content 
of  good  milk. 


Care  of  Children  235 

The  points  of  special  importance  to  observe  in 
the  feeding  are:  Make  milk  lukewarm  before 
giving  it  to  an  infant,  but  do  not  warm  it  until  it  is 
required  because  germs  multiply  rapidly  in  warm 
milk.  For  this  reason  milk  that  is  kept  warm  for  a 
number  of  hours  in  a  thermos  bottle  may  be  very 
injurious  to  a  child.  To  warm  the  milk:  remove 
the  stopper  from  the  bottle,  put  a  nipple  on  the 
latter,  being  careful  not  to  touch  the  part  that  is  to 
go  in  the  child's  mouth,  stand  the  bottle  in  a  pan 
containing  enough  hot  water  to  reach  beyond  the 
upper  level  of  the  milk.  To  test  the  temperature 
of  the  milk,  invert  the  bottle  and  allow  a  few  drops 
to  fall  on  the  front  surface  of  your  wrist. T 

Ascertain  if  the  hole  in  the  nipple  is  the  right 
size  at  the  same  time  as  you  test  temperature.  If 
it  is,  when  the  bottle  is  inverted,  the  milk  will  flow 
continuously  in  slow  drops,  but  not  in  a  continuous 
stream.  If  the  hole  is  too  small  enlarge  it  by  in- 
serting a  heated  knitting  needle  in  the  hole.  If  the 
latter  is  too  large  the  nipple  should  be  discarded  or, 
if  you  have  not  a  substitute,  take  special  care  to 
regulate  the  flow  of  the  milk  by  the  slant  of  the 
bottle. 

Always  hold  the  bottle  at  a  slant  that  will  just 
allow  the  infant  to  get  the  milk  without  undue  effort. 

Do  not  allow  a  baby  to  sleep  while  it  is  being  fed. 
This  will  be  more  easily  prevented  if  you  hold  it  in 
your  lap  during  the  process. 

1  The  arm  is  more  sensitive  to  changes  of  temperature  than  the 
hand. 


236  Nursing  Methods 

Do  not  allow  a  baby  to  suck  the  nipple  after  the 
milk  is  finished,  for  by  doing  so  it  will  get  air  into 
its  stomach  and  intestines  and  some  physicians 
believe  that  all  undue  sucking  of  nipples,  or 
of  the  fingers,  or  of  pacifiers,  by  causing  excessive 
movement  of  the  soft  tissue  at  the  back  of  the 
throat,  is  conducive  to  the  undue  development 
of  this  tissue  and  consequently  of  the  growth 
of  adenoids. 

After  a  feeding,  change  the  infant's  diapers  if 
necessary  and  then  put  it  in  its  crib.  A  baby 
should  never  be  played  with  or  rocked  after  a 
feeding. 

Especially  in  hot  weather,  infants  need  water 
between  feedings,  and  water  that  has  been  boiled 
for  three  minutes  should  be  kept  for  the  purpose. 
A  fresh  supply  should  be  prepared  daily  and  kept 
in  a  tightly  corked  bottle  that  has  been  boiled. 
The  water  should  not  be  actually  cold  when  it  is 
given  to  the  child  and  nothing  should  be  added  to 
it  unless  prescribed  by  a  doctor.  The  baby  will 
usually  take  as  much  as  it  needs.  Restlessness  is 
apparently  often  due  to  thirst  for  a  baby  is  fre- 
quently quieted  when  given  a  drink. 

Procedure  in  preparing  a  feeding :  Roll  up  your 
sleeves  above  the  elbows  and  scrub  your  hands 
and  arms. 

Put  on  a  clean  apron. 

Arrange  your  equipment:  Spread  the  oilcloth 
where  you  are  to  work ;  place  the  basket  with  the 
inverted  bottles  at  the  left  side;  the  pitchers  and 


Care  of  Children  237 

bottle  of  milk  in  the  center;  the  measures,  spoons, 
dipper,  and  other  supplies  at  the  right. 

Place  your  prescription  where  you  ean  read  it 
easily. 

Take  the  cover  from  the  milk  bottle  with  the 
prong. 

If  the  prescription  calls  for  top-milk,  remove  the 
number  of  ounces  required. 

The  two  following  prescriptions,  can  be  used  for 
class: 

1^  \y%  ozs.  sugar;  12  ozs.  of  7%  top-milk;  20 
ounces  of  boiled  water.  *  Of  this  give  7  feedings  of 
4  ounces  each. 

]$  i}/2  ozs.  sugar;  30  ozs.  of  4%  milk;  12  ozs.  of 
boiled  water.  Of  this  give  6  feedings  of  6  ounces 
each. 

(The  only  difference  in  procedure  in  filling  these 
two  prescriptions  is  in  the  preparation  of  the  milk.) 

Put  the  amount  of  sugar  required  into  the 
graduated  measure  and  a  little  of  the  water.  Stir 
the  sugar  until  it  is  dissolved. 

For  prescription  I,  remove  the  upper  sixteen 
ounces  from  a  bottle  of  milk.  To  do  this  open  the 
dipper  as  shown  in  Fig.  49,  and  lower  it  into  the 
cream  until  its  upper  edge  is  just  below  the  upper 
surface  of  the  cream,  then  draw  up  the  lower  part 
of  the  dipper  until  it  is  tightly  closed;  raise  the 

1  Plain  water  used  txs  dilute  milk  for  infant  feeding  should  be 
boiled,  for  three  minutes,  long  enough  before  it  will  be  required  to 
be  absolutely  cold  when  added  to  the  milk.  Recipes  for  preparing 
cereal  waters  are  printed  on  the  packages  of  the  cereal  sold  for 
this  purpose.  These  also  must  be  cold  when  used. 


238 


Nursing  Methods 


dipper  and,  holding  it  over  an  empty  pitcher,  open 
it  again.  The  Chapin  dipper  holds  just  one  ounce 
and  therefore  this  procedure  will  have  to  be  carried 
out  sixteen  times,  but,  after  the 
first  ounce  is  removed,  it  will  not 
be  necessary  to  open  the  dipper 
when  you  lower  it  into  the  cream. 
Stir  the  top  milk  with  the  glass 
rod  until  it  is  thoroughly  mixed. 
For  prescription  2,  empty  the 
whole  bottle  of  milk  into  a  pitcher 
and  then  either  stir  it  well  or 
else  pour  it  back  into  the  bottle 
and  again  into  the  pitcher,  for  it 
is  important  that  the  cream  and 
milk  be  thoroughly  mixed. 

Hold  the  graduated  measure 
with  the  line  of  the  amount  you 
require  on  a  level  with  your  eyes 
(be  sure  to  notice  how  high  the  sugar  solution  conies 
and  allow  for  this),  pour  in  the  milk  and  then  the 
remainder  of  the  water. 

Stir  the  mixture  very  thoroughly  and  then  pour 
it  into  the  bottles;  for  prescription  I,  pour  four 
ounces  into  each  of  seven  bottles,  and,  for  prescrip- 
tion 2,  six  ounces  into  each  of  six  bottles. 

(When  lime  water  is  prescribed  it  can  be  added  at 
any  time  before  the  final  stirring.  The  ingredients 
are  usually  mixed  in  the  order  given  above  so  that 
(i)  the  sugar  may  be  thoroughly  dissolved  before  the 
milk  is  added;  (2)  adding  the  bulk  of  the  water  last  is 


Fig.  49. 
Chapin  dipper. 

(a)  Dipper  closed 

(b)  Dipper  open 


Care  of  Children 


239 


of  help  in  getting  the  ingredients  thoroughly  mixed. 
It  is  important  that  the  mixture  be  well  stirred  just 
before  it  is  put  into  the  bottles,  as  otherwise  the  feed- 
ings may  not  all  contain  the  same  amount  of  cream.} 

Plug  the  bottles  tightly  with  absorbent  cotton 
or  rubber  corks  and  place  them  in  the  basket.  If 
the  milk  is  not  to  be  pasteurized  put  the  basket 
and  its  contents  in  the  refrigerator  amidst  the  ice. 

If  the  milk  is  to  be  pasteurized  have  an  extra 
feeding  bottle  and 
put  some  milk  or 
water  into  it  and  a 
dairy  thermometer, 
as  in  Fig.  50.  Stand 
the  basket  of  bottles 
in  the  pot  and  pour 
enough  cold  water 
around  them  to  come 
a  little  above  the 
level  of  the  milk  in 
the  bottles.  Put  the 
pot  on  the  stove  and 
let  the  water  heat 
slowly  until  the 
liquid  in  the  extra 
bottle  is  140°  F. 
Then  turn  out  the 

flame,  but  watch  the  thermometer  and,  if  necessary, 
apply  heat  again.  The  temperature  of  the  milk  is 
to  be  kept  at  140°  F.  for  thirty  minutes. 

At  the  conclusion  of  the  thirty  minutes  remove 


Fig.  50.     Milk  bottles  arranged  in 
basket  for  pasteurization. 


240  Nursing  Methods 

the  basket  of  bottles,  stand  it  in  tepid  water  and 
cool  this  as  quickly  as  possible  without  breaking 
the  bottles.  This  can  be  done  by,  at  short  inter- 
vals, adding  small  pieces  of  ice  or  cold  water  to 
that  surrounding  the  bottles. 

As  soon  as  the  bottles  are  cool  enough  put  them 
in  the  refrigerator. 

Clean  and  put  away  the  equipment :  Wash  all  the 
utensils  in  (i)  cold  water;  (2)  hot  soapsuds;  (3) 
clear  hot  water.  Let  the  water  run  into  and  over 
them ;  this  is  especially  necessary  in  the  case  of  the 
glass  utensils  in  order  to  keep  them  from  breaking. 
Invert  the  utensils  to  drain  and  when  they  are  dry 
put  them  away.  It  is  well  if  possible  to  keep  these 
utensils  solely  for  the  preparation  of  the  milk  and 
either  in  a  covered  box  or  rolled  in  clean  towels. 
If  this  is  not  done  they  should  be  scalded  before 
use.  The  method  of  cleaning  the  bottles  and 
nipples  has  been  already  described. 


CHAPTER  X 
Bandaging 

Uses,  kinds  and  sizes  of  bandages.  How  to  make  bandages. 
Points  to  remember  when  bandaging.  Demonstration  24: 
Circular,  spiral,  spiral  reverse,  and  figure-eight  bandages.  Band- 
ages for  the  leg,  foot,  heel,  knee,  arm,  fingers,  shoulder.  Tailed 
and  handkerchief  bandages  and  slings. 

Equipment:  Bandages  of  different  widths. 

A  bandage  roller  if  possible. 

Pieces  of  muslin  for  tailed  and  handkerchief 
bandages  and  slings. 

Bandages  are  used  chiefly:  To  keep  surgical 
dressings,  splints,  poultices  and  the  like  in  place; 
to  control  the  circulation  of  blood  in  a  part  when 
there  is  hemorrhage  or  swelling;  to  limit  motion 
and  to  afford  support. 

Gauze  (cheesecloth)  and  muslin  are  the  materi- 
als most  commonly  used  for  bandages,  but  various 
others  are  also  employed;  e.g.,  crinoline  impreg- 
nated with  plaster  which,  when  applied,  consti- 
tutes what  is  known  as  a  plaster  cast,  flannelet, 
Canton  flannel,  and  rubber,  also  bandages  of  a 
special  loose-meshed  material  can  now  be  bought, 
at  stores  dealing  in  surgical  supplies,  that  are  par- 
ticularly good  for  affording  support  to  weak  ankles 


16 


241 


242  Nursing  Methods 

and  making  pressure  upon  varicose  veins  and 
swollen  parts.  Gauze  bandages  are  usually  pre- 
ferred to  others  for  keeping  surgical  dressings  in 
place,  because  they  are  lighter  and  cooler  and  more 
easily  adjusted  than  those  of  other  materials,  but 
the  gauze  is  not  firm  enough  to  be  used  when  pres- 
sure and  support  are  necessary. 

The  average  widths  of  bandages  used  for  differ- 
ent parts  of  the  body  are :  For  the  fingers,  one  inch 
wide;  for  the  head,  arm,  and  foot,  two  to  three 
inches,  according  to  the  size  of  the  patient ;  for  the 
thigh  and  trunk,  three  to  four  inches ;  for  the  heel, 
three  inches. 

Making  bandages :  When  bandages  are  made  in 
large  numbers  they  are  rolled  and  cut  by  machin- 
ery but,  for  individual  use,  the  material  for  a 
bandage  can  be  cut  or  torn  and  rolled  by  hand. 
However,  it  must  be  properly  rolled  or  the  bandage 
will  be  difficult  to  adjust.  The  points  of  special 
importance  are:  The  material  must  be  smooth 
(without  wrinkles)  and  tightly  rolled  and  the 
selvage  and  ravelings  removed.  The  selvage  is 
removed  before  and  the  ravelings  after  the  mate- 
rial is  rolled.  The  reason  for  the  removal  of  the 
selvage  is  that  it  does  not  stretch  as  much  as  the 
rest  of  the  material  and  thus  increases  the  difficulty 
of  getting  uniform  pressure.  To  roll  a  bandage  by 
hand  fold  one  end  of  the  strip  of  material  upon 
itself  several  times  until  a  small,  but  firm,  roll  is 
formed.  Then  hold  the  free  part  of  the  strip 
between  the  thumb  and  index  fingers  of  the  right 


Bandages  243 

hand,  hold  the  roll  with  the  thumb  of  the  left 
hand  on  one  end  and  the  first  finger  on  the  other, 
and  rotate  the  roll  until  the  bandage  is  completed. 


Fig  51.     Rotting  a  bandage  by  hand. 

Items  of  importance  to  remember  when  bandag- 
ing are:  (i)  A  bandage  must  be  put  on  tightly 
enough  to  insure  its  remaining  in  place,  but  it  must 
never  be  so  taut  that  it  causes  pain  or,  except  when 
prescribed  for  the  purpose,  interferes  with  the  cir- 
culation. (2)  When  there  is  a  wound  or  acute 
inflammation  a  bandage  is  generally  put  on  par- 
ticularly loosely,  but,  when  it  is  intended  to  afford 
support  or  pressure,  it  is  usually  put  on  as  tightly 
as  possible  without  causing  the  effects  mentioned 
above.  In  such  case  it  is  particularly  important 
that  it  be  put  on  in  such  a  manner  that  the  pressure 


244 


Nursing  Methods 


is  uniform  over  the  entire  part  that  is  bandaged. 
That  it  may  be  so,  no  one  turn  of  the  bandage  must 
not  be  tighter  than  another  and  each  turn  must 
overlap  the  other  an  equal  distance.  The  first 
turn  taken  when  starting  the  bandage  is  particu- 
larly likely  to  be  made  too  tight  unless  care  is  taken 
to  avoid  it.  (3)  When  bandaging  a  limb,  the  toes 
or  fingers  are  left  uncovered  if  possible,  even  when 
they  are  not  to  be  moved,  because  their  condition 
shows  if  the  bandage  is  too  tight.  Indications  that 
it  is  are  a  deep  red  or  bluish  color,  and  coldness  of 
the  skin.  This  precaution  is  especially  important 
when  there  is  inflammation  because,  even  when 
the  bandage  is  loosely  applied  the  swelling  in  the 
part  may  increase  and  make  it  too  tight. 

When  bandaging,  hold  the 
bandage  roll  side  upward  in 
your  right  hand,  begin  to 
bandage  at  the  distal  end  of 
the  part  to  be  covered  and 
work  upward.  Always  pin  or 
tie  a  bandage  so  that  the  pin 
or  knot  will  not  come  in  con- 
tact with  any  part  of  the 
patient's  body  or  where  he 
will  not  lie  upon  it.  To  tie  a 
Fig.  52.  Circular  bandage,  tear  a  few  inches  of 
bandage.  the  material,  twist  the  two 

ends  around  each  other,  pass 
them  in  opposite  directions  around  the  limb  and 
then  tie  them  over  the  twist. 


Bandages 


245 


The  forms  of  bandages  in  most  common  use  are 
what  are  known  as  the  circular,  spiral,  the  spiral 
reverse,  the  figure  of  eight  and  the  spica. 

The  circular  bandage  consists  of  two  or  three 
turns  made  around  a  part,  each  turn  covering  the 
preceding  one.  (See  Fig.  52.) 

The  spiral  bandage  can  be  applied  only  to  parts 
of  about  uniform  circumference.  It  consists  of 


53-     Spiral  bandage. 


Fig.  $4.     Spiral  reverse. 


Fig.  55.  Fore- 
arm with  simple 
spiral  below  and 
the  reverse  above. 


circular  turns,  each  one  made  higher  than  the  pre- 
ceding one,  but  overlapping  it  about  one  half  its 
width. 
The  spiral  reverse  is  similar  to  the  spiral  band- 


246 


Nursing  Methods 


age,  but,  in  each  turn,  the  material  of  the  bandage 
is  reversed,  i.e.,  turned  over  upon  itself.  To  make 
the  reverse,  place  the  thumb  of  the  left  hand  at  the 
point  where  the  reverse  is  to  be  made,  pronate  the 
right  hand  (in  which  the  roll  is  held)  and  thus 
double  the  bandage  upon  itself,  as  shown  in  Fig. 
54,  and  make  sufficient  traction  on  the  bandage  to 
draw  the  turn  into  place.  Make  each  reverse 
directly  above  the  preceding  one.  By  thus  re- 
versing the  bandage  the  turns  can  be  adjusted  to 
the  contours  of  the  body;  this  makes  the  spiral 
reverse  a  particularly  suitable  bandage  for  the  legs 
and  arms. 


Fig.  56.     Figure-eight  bandage. 


The  figure-eight  bandage  consists  of  a  series  of 
oblique  turns  alternately  ascending  and  descending 
and  crossing  each  other  in  such  a  manner  that  they 
form  the  figure  eight  around  the  part.  This  forms 
the  basis  for  many  special  bandages,  such  as  those 
used  on  joints. 


Bandages 


247 


57-    Recurrent 
bandage. 


The  recurrent  bandage  consists  of  a  series  of 

turns  passed  back  and  forth  across  the  part  to  be 

bandaged,  each  turn  overlap- 
ping the  other  one  half  its 

width.    The  ends  are  secured 

by  a   circular   turn   around 

them .  The  recurrent  bandage 

is  used  chiefly  to  retain  dress- 
ings in  place  on   the  head, 

ends  of  the  fingers  or  toes. 
To  bandage  the  foot,  take 

a  circular  turn  around  the 

ankle,   carry  the  roll  down 

over    the    top   of    the   foot 

toward  the  toes,  then  under 

the  foot   near   the   base  of 

the  toes  and  back  over  the  top  of  the  foot,  cross- 
ing the  first  turn  in 
the  middle  line  of 
the  foot,  directly 
above  the  toes ;  pass 
the  roll  upward  and 
back  of  the  ankle, 
then  down  again 
over  and  under  the 
foot  as  before.  Con- 
tinue the  turns  until 
the  foot  is  covered, 
Fig.  5$.  Foot  bandage.  making  each  one 

higher     than     the 

other  and  covering  the  preceding  one  about  half 


248 


Nursing  Methods 


its  width.    It  will  be  seen  that  this  bandage  is  on 

the  principle  of  the  figure-eight. 
To  bandage  the  heel,  use  a  three-inch  bandage, 

take  a  couple  of  turns  around  the  heel  (i)  then 

carry  the  roll  around 
the  ankle,  covering 
the  upper  part  of  the 
turns  around  the 
heel  for  at  least  one 
inch,  pass  obliquely 
over  the  top  of  the 
foot;  (2)  and  then 
under  the  foot  (just 
above  the  toes),  up 
over  the  top  of  the 
foot,  crossing  the 


Fig.  59.     Heel  bandage. 


downward  turn  in  the  middle  of  the  foot;  (3) 
around  the  ankle  (covering  half  of  the  former 
turn)  back  again  over  the  top  of  the  foot;  (4) 
under  the  foot,  and  up  around  the  foot ;  (5)  take 
two  turns  around  the  ankle  (6,  7).  The  figures 
refer  to  those  in  Fig.  59. 

To  bandage  the  leg,  take  two  turns  around  the 
ankle  and  proceed  up  the  leg  with  either  reverse 
or  figure-eight  turns.  It  is  well,  especially  if  the 
patient  is  not  confined  to  bed  after  making  three 
or  four  turns  (either  reverse  or  figure-eight),  to 
carry  the  bandage  up  and  around  the  leg  above 
the  calf  then  down  around  the  leg  to  above  the 
regular  turns  and  afterwards  continue  as  at  first. 
The  turn  around  the  calf  helps  to  keep  the  band- 


Bandages 


249 


age  from  slipping.  The  knee  is  covered  only  when 
necessary,  in  which  case  proceed  as  for  the  elbow 
bandage. 

To  apply  a  spica  to  the  shoulder,  fix  the  free  end 
of  the  bandage  by  taking  a  couple  of  circular  turns 
around  the  middle 
of  the  arm  of  the 
injured  side,  make 
one  or  more  re- 
verse or  figure- 
eight  turns,  then 
carry  the  bandage 
across  (for  the  right 
shoulder)  the  chest 
or  (for  the  left 
shoulder)  the  back, 
continue  the  turn 
around  the  body 
(passing  under  the 

armpit  of  the  unin-          pfg.  6o.    Sfnca  of  the  shoulder. 

jured  side)  back  to 

the  injured  side,  pass  the  bandage  obliquely  around 
the  arm  on  this  side  (forming  the  figure-eight)  and 
then  around  the  trunk  as  before.  Continue  to  make 
these  turns  until  the  shoulder  is  covered.  Overlap 
the  turns  on  the  arm  one  half  their  width  but  con- 
verge the  bandage  as  it  crosses  the  chest  and  back 
so  that  the  fold  under  the  armpit  will  be  narrow. 
A  spica  for  the  thigh  is  put  on  in  the  same  manner 
as  the  shoulder  spica  except  that  the  turns  around 
the  trunk  are  carried  upward  to  the  waistline. 


250 


Nursing  Methods 


To  bandage  the  arm  take  one  or  two  circular 
turns  around  the  wrist  and  then  proceed  up  the 
arm  with  either  figure-eight  or  reverse  turns,  do 
not  cover  the  elbow  unless  necessary  if  the  bandage 
is  to  be  continued  up  the  upper  arm,  when  you 
reach  the  elbow,  carry  the  bandage  up  on  the  inner 

side  of  the  joint;  take 
a  circular  turn  around 
the  arm  above  the  joint 
and  proceed  as  on  the 
forearm. 

When  the  elbow  is  to 
be  covered,  discontinue 
the  figure-eight  or  re- 
verse turns  about  two 
inches  below  the  joint, 
flex  the  forearm,  carry 
the  bandage  upward 
and  around  the  el- 
bow, in  a  manner  to 

have  the  point  of  the  latter  in  the  center  of  the 
bandage,  bring  the  bandage  downward  inside  the 
joint  and  around  the  arm  (keeping  the  upper  edge 
of  the  bandage  just  below  the  point  of  the  elbow), 
pass  upward  crossing  the  previous  turn  on  the 
inside  of  the  joint,  pass  around  the  elbow  (keeping 
the  lower  edge  of  the  bandage  just  above  the  point 
of  the  joint) ,  and  then  bring  the  bandage  downward 
again.  Repeat  the  turns,  making  that  on  the  fore- 
arm lower  and  that  on  the  upper  arm  higher  than 
the  preceding  ones,  then  take  a  circular  turn 


Fig.  61.    Elbow  bandage. 


Bandages 


251 


Fig.  62.  Hand  band- 
age, fingers  not  in- 
cluded. 


around  the  upper  arm  and  proceed  with  the  figure- 
eight  or  reverse. 

To  bandage  the  hand  without  including  the 
fingers,  take  a  circular  turn  around  the  hand  at  the 
base  of  the  ringers  and,  on  reach- 
ing the  back  of  the  hand  for  the 
second  time  pass  the  bandage  ob- 
liquely across  it  and  around  the 
front  of  the  wrist,  then  down 
across  the  back  of  the  hand, 
crossing  the  former  turn  in  the 
middle  of  the 
hand,  around  the 
palm  and  up 
across  the  back 
of  the  hand  again. 
Repeat  the  turns  until  the  hand  is 
covered,  finish  with  a  circular  turn 
around  the  wrist. 

To  bandage  the  hand  when  the 
fingers  are  to  be  covered  put  gauze 
or  cotton  between  the  fingers  and 
over  the  tops  and,  it  is  well  to  put 
powder  on  the  cotton ;  these,  if  there 
is  a  wound,  should  be  sterile.  Place 
the  free  end  of  the  bandage  about 
the  middle  of  the  palm  of  the  hand, 
in  the  center  take  a  turn  over  the 
fingers,  and  down  to  the  middle  of 
the  back  of  the  hand,  then  take  re- 
current turns,  back  and  forth,  across  the  tops  of  the 


Fig.  63.  Hand 
bandage.  Fingers 
covered  with  re- 
current bandage. 
Thumb  covered 
separately  and 
first  with  figure  8 
or  spiral  reverse 
turns. 


252  Nursing  Methods 

fingers,  first  on  one  side  and  then  on  the  other  of 
the  first  turn.  Hold  these  turns  in  place  with  the 
thumb  and  first  finger  of  the  left  hand  until  the 
ringers  are  covered,  then  secure  them  in  place  with 
a  circular  turn  and  bandage  the  hand  as  previ- 
ously described.  If  the  thumb  is  to  be  bandaged 
it  is  usually  done  before  the  hand. 

To  bandage  the  thumb  or  a  finger.  If  the  tip 
is  to  be  covered,  take  two  or  three  recurrent  turns 
across  the  top  and  secure  them  in  place  with  a 
circular  turn,  otherwise  begin  with  the  circular 
turn  and  proceed  down  the  finger  or  thumb  with 
either  figure-eight  turns  or  reverse.  If  more  than 
one  finger  is  bandaged  and  also  the  hand,  it  is  cus- 
tomary to,  after  getting  to  the  base  of  one  finger, 
take  a  turn  across  the  back  of  the  hand,  around 
the  wrist,  up  the  palm  of  the  hand,  then  make  a 
turn  or  two  to  carry  the  bandage  to  the  top  of  the 
next  finger  that  is  to  be  bandaged  and  begin  to 
bandage  as  on  the  first  finger. 

Slings,  Handkerchief,  and  Tail  Bandages 

The  sling  illustrated  in  Fig.  64  and  the  handker- 
chief bandages  can  be  made  by  folding  a  large 
handkerchief  or  a  piece  of  muslin  or  other  firm 
material  (about  three  quarters  to  one  yard  square) 
diagonally,  or  the  material  can  be  cut  diagonally. 
The  result  is  a  triangle  as  shown  on  Fig.  65.  For 
the  sling  shown  in  Fig.  66,  either  a  triangular  piece 
of  material  with  its  central  point  folded  in,  or  a 


Bandages 


253 


straight  piece  can  be  used.     The  tail  bandages  con- 


Fig.  64.     Sling.     The  two  points  are  tied  at 
the  back  of  the  neck. 

sist  of  muslin  or  similar  material,  long  in  propor- 


Fig.  6$.     Shape  of  material  for  sling  shown  in  Fig.  64  and 
for  the  handkerchief  bandages. 

tion  to  their  width  (the  size  depending  upon  the 
part  to  be  covered)  split  at  each  end.    The  meth- 


254  Nursing  Methods 

ods  of  adjusting  these  slings  and  bandages  can 
be  easily  learned  by  studying  and  copying  the 


Fig.  66.    Sling. 

illustrations  and,  therefore,  space  will  not  be  taken 
to  describe  them. 


Fig.  67.    A  handkerchief  bandage  for  the  head. 


Bandages 


255 


Fig.  68.  Hand- 
kerchief bandage 
for  the  hand. 


Fig.  69.    Handkerchief  bandagefor  the  heel. 


Fig.  70.    Handkerchief  bandage  for  thefoot. 


Fig.  71.     Four-tailed  bandage 
of  the  head. 


Fig.  72.     Tail  bandage  on 
back  of  head. 


256  Nursing  Methods 


73-     Tail  bandage  on 
forehead. 


Fig.  74.     Tail  bandage  for 
chin. 


Fig.  75,      Four-tail 
knee  bandage. 


PART  H 
CHAPTER  XI 

First  Aid  Treatment  in  Accident  and  Other 
Emergencies 

The  principles  of  first  aid  treatment.  Nature,  causes  and  first 
aid  treatment  of :  Unconsciousness;  fainting  or  syncope;  hysteria; 
sunstroke;  heat  prostration;  convulsions;  chills.  Demonstra- 
tion 25:  First  aid  treatment  in  the  above  emergencies,  including 
lifting  and  carrying  an  unconscious  patient  who  has  fallen  to  the 
ground. 

Equipment  for  demonstration:  Hot-water 
bottles  and  some  large  glass  bottles  and  corks  to  act 
as  substitutes. 

Covers  for  the  bottles. 

Ice-cap  and  cover  and  a  basin  of  ice  and  com- 
presses for  the  head  as  in  Demonstration  21. 

Bath  towel  and  hand  towels. 

A  foot-tub  about  three  quarters  full  of  water 
105°  F. 

A  bath  thermometer. 

A  mouth  thermometer 

The  baby  doll  model. 

The  principles  of  first  aid  treatment:  In  all 
serious  emergencies  the  following  points  are  to  be 
remembered : 

17  257 


258  Nursing  Methods 

Do  not  get  excited. 

Send  for  a  doctor  at  once  and,  if  possible,  let 
him  know  what  has  occurred,  but  do  not  waste 
time  trying  to  get  or  give  details. 

Do  not,  unless  absolutely  necessary,  attempt  to 
give  treatment  that  can  be  only  carried  out  prop- 
erly by  a  physician  or  surgeon. 

Do  not,  without  a  physician's  advice,  unless 
absolutely  necessary,  give  drugs  other  than  the 
simple  remedies  mentioned  in  the  following  pages. 

Do  not  molest  doctors  or  nurses  with  your 
advice. 

If  there  is  nothing  for  you  to  do  keep  away  and, 
if  necessary,  keep  others  away.  A  crowd  around 
a  person  who  has  met  with  an  accident  may  be 
very  harmful  for  it  is  likely  to  excite  and  disturb 
her  and  to  restrict  her  air  supply. 

When  an  accident  occurs  out  of  doors  it  is  well 
to  get  the  patient  into  a  house  as  quickly  as  possible 
but,  before  moving  her,  ascertain  if  there  are  any 
signs  of  hemorrhage  or  fracture  and  if  so  take  the 
means  described  later  to  prevent  harm  being  done 
during  the  moving.  If  possible,  when  the  patient 
is  to  be  taken  home,  send  someone  ahead  to  notify 
the  family  and  to  give  warning  that  the  patient 
is  not  to  be  excited  and  that  a  bed  should  be  pre- 
pared for  her.  Naturally,  endeavor  must  be  made 
not  to  alarm  the  family. 

If  the  patient  is  frightened,  reassure  her  and,  if 
there  is  a  severe  wound  or  hemorrhage,  take  means 
to  prevent  her  seeing  the  extent  of  the  injury. 


First  Aid  Treatment          259 

Keep  the  patient  quiet  and  lying  down  with, 
unless  there  is  apparently  some  injury  to  the  head 
or  her  face  is  flushed,  her  head  as  low  as  possible; 
for  reasons  given  later,  when  the  conditions  just 
mentioned  exist,  the  head  is  to  be  slightly  raised, 
though  the  patient  is  to  be  kept  lying  down. 

Loosen  the  collar,  tight  bands,  and  corsets  for, 
when  the  nervous  system  is  depressed,  even  a  very 
moderate  constriction  interferes  with  breathing 
and  the  circulation  of  the  blood  and  after  a  serious 
accident  there  is  always  more  or  less  depression 
of  the  nervous  system. 

Do  not  try  to  give  an  unconscious  person  liquid 
by  mouth  for,  when  unconscious,  a  person  is  not 
likely  to  be  able  to  swallow  and  the  fluid  may  get 
into  her  trachea  and  cause  choking,  but,  if  the 
person  is  able  to  drink,  and  there  is  no  reason  to 
suspect  hemorrhage,  give  all  the  water  possible 
and  hot  drinks  such  as  tea  and  coffee. 

If  an  unconscious  person  vomits,  turn  her  head 
on  one  side  so  that  the  vomitus  will  run  out  of  her 
mouth,  otherwise,  it  may  get  into  the  trachea. 

Unconsciousness 

Unconsciousness,  known  also  as  coma,  is  a  state 
in  which  an  individual  is  insensible  and  cannot  be 
aroused.  It  indicates  depression1  of  the  brain, 
especially  that  part  known  as  the  cerebrum.  It 
results  from  many  causes,  some  of  the  more  com- 

1  Inability  to  function  properly. 


26o  Nursing  Methods 

mon  ones  being:  Shock,  collapse,  fainting,  apo- 
plexy, asphyxia,  sunstroke,  poisoning  either  by 
poisons  generated  within  the  body,  as  described 
under  shock,  or  by  drugs  or  alcoholic  beverages. 

When  a  person  is  discovered  unconscious  it  is 
sometimes  very  difficult  for  even  a  physician  to 
determine  the  cause  and,  therefore,  it  is  likely  to 
be  quite  impossible  for  anyone  else  to  do  so.  En- 
deavor should  be  made,  however,  to  ascertain  if  the 
condition  is  due  to  poisoning  by  drugs,  sunstroke, 
hemorrhage,  or  asphyxia,  because  these  conditions 
require  immediate  special  attention.  If  this  is 
not  the  case  and  the  patient  is  not  having  convul- 
sions and  her  breathing  does  not  show  signs  of 
ceasing,  until  the  doctor  arrives,  merely  follow  the 
instructions  given  above,  and,  if  the  pulse  becomes 
weak  and  rapid,  those  given  under  Shock. 

Shock  and  Collapse 

Shock  and  a  similar  state  known  as  collapse  are 

conditions  in  which  the  nervous  system  is  depressed 
and  the  blood  is  not  circulating  properly.  As  de- 
pression of  the  nervous  system  interferes  with  the 
circulation  of  the  blood  and  inefficient  circulation 
of  blood  in  the  brain  and  spinal  cord  will  cause  de- 
pression of  the  nervous  system,  it  is  not  always 
known  which  of  the  two  conditions  is  responsible 
for  the  other.  In  order  to  understand  this  and  why 
shock  is  produced  by  the  causes  mentioned  later 
it  is  necessary  to  recall  the  following  facts:  (i) 


First  Aid  Treatment          261 

The  action  of  the  heart  is  regulated  by  impulses 
coming  to  it  over  nerve  fibers  extending  from  the 
brain.  (2)  The  blood-vessels  are  maintained  in  a 
state  of  partial  contraction  or  tone  by  nerve  im- 
pulses coming  from  the  brain  and  spinal  cord  and, 
if  anything  happens  to  depress  (lessen  the  activity 
of)  any  part  of  the  nervous  mechanism  concerned 
in  maintaining  this  state  of  tone,  the  blood-vessels 
dilate  and  this  not  only  interferes  with  the  action 
of  the  heart  but  with  the  power  of  the  blood-vessels 
to  propel  the  blood  onward  through  the  body. 
This  is  the  state  of  affairs  existing  in  shock.  (3) 
If  the  heart  muscle  and  the  muscle  tissue  in  the 
walls  of  the  blood-vessels  are  not  in  a  healthy  con- 
dition they  will  not  respond  properly  to  nerve 
impulses.  (4)  The  action  of  the  heart  is  also  inter- 
fered with  if  the  amount  of  blood  in  the  vessels  is 
reduced  and  this  occurs  when  there  is  loss  of  blood 
from  the  vessels,  or  excessive  loss  of  fluid  from  the 
body  as  the  result  of  continued  vomiting,  diarrhea, 
or  profuse  perspiration,  also,  if  the  blood-vessels 
dilate,  practically  the  same  condition  will  be 
present  because,  as  just  stated,  the  blood  will  not 
pass  onward  through  the  veins. ' 

No  one  of  the  above  conditions  can  occur  to  a 
marked  extent  without  inducing  the  other  nor 
involving  all  other  parts  of  the  body,  because  all 

1  The  body  can  be  likened  to  a  furnace,  with  machinery  at- 
tached. The  machinery  will  only  work  while  the  fire  in  the  fur- 
nace burns,  and  there  will  only  be  fire  if  coal  or  other  fuel  is 
provided  and  also  air  and,  consequently,  oxygen,  for  burning  con- 
sists in  the  union  of  oxygen  with  matter. 


262  Nursing  Methods 

the  organs  depend  to  some  extent  upon  nerve  im- 
pulses to  make  them  work,  and  they  also  need  the 
oxygen  and  fuel  material  brought  to  them  by  the 
blood  to  give  them  the  energy  which  they  need  to 
carry  on  the  work,  and  the  nutrient  material  to 
repair  the  waste  which  the  work  entails.  The 
nervous  system,  especially  the  brain,  will  be  the 
first  part  of  the  body  depressed  if  its  nutrient, 
oxygen  and  fuel  supply s  are  limited. 

To  say  that  an  organ  is  depressed  implies  that  its 
power  to  function  (carry  on  its  work)  is  reduced. 
The  opposite  of  depression  is  stimulation.  Any- 
thing which  stimulates  or  excites  an  organ  enables 
it  to  work  more  rapidly  and  strongly,  but  over- 
stimulation  ends  in  depression,  because  the  organ 
becomes  fatigued.  For  this  reason  fright,  severe 
pain,  intense  anger  will  eventually  induce  a  more 
or  less  intense  state  of  shock.  You  have  all,  prob- 
ably, at  times  experienced  a  sensation  of  faintness 
following  pain  or  the  emotions  just  mentioned, 
and  this  sensation  is  induced  by  a  mild  state 
of  the  conditions  described  in  the  preceding 
paragraphs. 

The  common  causes  of  shock  are :  Hemorrhage 
or  excessive  loss  of  fluid  from  the  body  from  such 
causes  as  those  mentioned  on  page  261 ;  exhaustion, 
as  from  starvation,  exposure  to  cold,  severe  mental 
strain,  or  protracted  illness  (in  the  last-mentioned 
case  the  condition  is  spoken  of  as  collapse) ;  terror; 
intense  pain;  poisons,  either  those  taken  into  the 
body  or  those  formed  within  the  body. 


First  Aid  Treatment          263 

Poisons  will  be  formed  in  the  body  by :  (i)  Bac- 
teria, (2)  interference  with  the  chemical  processes 
(known  as  metabolism)  that  are  constantly  taking 
place  and  upon  which  life  depends ;  (3)  failure  of  the 
body  to  get  rid  of  waste  matter,  either  food  residue, 
which  should  be  eliminated  through  the  bowels ;  or 
the  waste  matter  arising  in  the  course  of  metabol- 
ism, which  should  be  expelled  chiefly  through  the 
kidneys  and  lungs ;  (4)  substances  produced  by  the 
chemical  changes  that  occur  in  tissues  when  they 
are  injured,  especially  when  they  are  macerated  or 
acted  upon  by  corrosive  drugs.  The  poisons  may 
cause  shock  by  depressing  the  nervous  system,  or 
by  weakening  the  muscle  of  the  heart  or  dilating 
the  blood-vessels 

The  symptoms  of  severe  shock  are :  The  pulse 
is  weak  and  usually  rapid;  the  breathing  shallow 
and  feeble;  the  skin  is  pale,  cold,  and  clammy;  the 
face  has  an  anxious  expression;  the  pupils  of  the 
eyes  are  more  or  less  dilated  and  the  body  tempera- 
ture falls ;  when  the  shock  follows  an  accident,  the 
patient  may  be  much  excited  for  a  time,  but  the 
excitement  will  be  followed  by  a  stupid  condition 
and,  very  commonly,  unconsciousness.  The  symp- 
toms of  shock  usually  develop  slowly  and  may  not 
be  apparent  for  some  time  after  an  accident,  par- 
ticularly if  the  person  is  excited,  but,  it  is  to  be 
remembered,  a  serious  accident  will  always  be 
followed  by  more  or  less  shock,  especially  if  it  is 
associated  with  conditions  that  cause  fear  or  in- 
volve much  destruction  of  tissue. 


264  Nursing  Methods 

The  symptoms  of  slight  shock  are  similar  to 
those  just  mentioned,  but  less  marked. 

Three  important  things  to  be  considered  in  the 
treatment  of  severe  shock,  and  to  prevent  shock 
are:  To  keep  the  patient  warm,  quiet,  and  in 
a  position  to  favor  the  flow  of  blood  to  the 
brain. 

For  the  first  requirement — warmth — wrap  the 
patient  in  blankets  or  whatever  suitable  substitute 
can  be  obtained  and,  as  soon  as  possible,  surround 
her  with  hot- water  bottles,  glass  bottles  can  be 
used  in  emergency.  To  avoid  breakage  while  fill- 
ing them,  pour  water  over,  as  well  as  into  them. 
It  is  to  be  remembered  that,  when  the  circulation 
in  the  skin  is  poor,  as  it  always  is  in  shock,  a  patient 
is  very  easily  burned. 

Quiet  is  essential  to  lessen  the  work  of  the  heart ; 
as  previously  stated,  the  action  of  the  heart  is 
greatly  interfered  with  and  any  extra  strain  may 
be  more  than  it  can  withstand.  To  insure  quiet  it 
is  important  to  reassure  the  patient,  for  fear  is 
likely  to  make  her  restless  and  also  to  make  the 
heart  beat  more  rapidly.  Though  all  tight  bands 
and  clothing  are  to  be  loosened  it  is  not,  as  a  rule, 
advisable  to  undress  a  patient  who  is  suffering 
from  shock  until  her  pulse  improves,  as  this  is  likely 
to  entail  too  much  movement. 

The  required  position  is  most  easily  obtained  by 
laying  the  patient,  without  pillows  under  her  head 
(except  in  the  conditions  mentioned  on  page  259), 
on  a  bed  or  couch  and,  if  the  symptoms  of  shock 


First  Aid  Treatment          265 

become  pronounced,  raising  the  foot  of  the  bed; 
this  can  be  done  by  resting  it  on  a  table  or  putting 
stools  or  a  pile  of  magazines,  etc.,  under  each  of 
the  legs  of  the  foot  of  the  bed.  If  the  individual 
is  out  of  doors  and  there  is  nothing  at  hand  to 
facilitate  getting  her  into  the  required  position, 
any  unevenness  of  the  ground  must  be  taken 
advantage  of.  Also  when  carrying  the  patient 
her  head  is  to  be  kept  low,  therefore,  the  short- 
est carrier  should  support  the  upper  part  of  the 
body. 

If  the  patient's  pulse  becomes  very  weak  before 
the  doctor  arrives,  she  can  be  given  half  a  teaspoon- 
ful  of  aromatic  spirits  of  ammonia  or  even  am- 
monia water1  in  about  two  to  three  tablespoonsful 
of  water,  or  the  bottle  of  ammonia  or  smelling  salts 
can  be  held  so  that  the  gas  will  pass  into  her  nose 
and  mouth.  It  can  be  given  in  the  latter  manner 
even  when  the  patient  is  unconscious,  but  care 
must  be  taken  in  such  case  because  the  ammonia 
is  very  irritating  to  the  membrane  of  the  nose  and 
mouth  and  to  eyes.  The  ammonia  must  not  be 
given  by  mouth  when  the  shock  is  due  to  poisoning 
by  irritant  drugs.  The  value  of  the  ammonia  in 
helping  to  overcome  shock  is  due  to  its  irritant 
action  which  gives  rise  to  nerve  impulses  that  pass 
to  the  brain  and  cord  and  are  transmitted  thence 
to  the  heart  and  blood-vessels. 

1  Only  half  to  one  eighth  this  amount  is  to  be  given  to  a  child, 
but,  except  in  extreme  emergency,  ammonia  should  not  be  given 
a  very  young  child. 


266  Nursing  Methods 

Fainting  or  Syncope 

Fainting  is  a  condition  of  temporary  uncon- 
sciousness brought  about  by  interference  with  the 
flow  of  blood  to  the  brain.  It  is  in  effect  a  mild 
stage  of  shock  or  collapse  and  is  brought  about  by 
the  same  causes.  Some  people,  however,  faint 
very  readily,  the  sight  of  blood,  the  slightest  pain 
or  nausea  being  sufficient  to  make  them  do  so. 
Probably  the  two  most  common  causes  for  this 
are  ill  health  and  suggestion.  Examples  of  sugges- 
tion are:  (i)  Some  people,  especially  those  who 
have  little  self-control,  having  heard  others  say 
that  they  fainted  on  seeing  blood  expect  to  do 
likewise  and,  therefore,  do ;  (2)  a  person  who  faints 
once,  may  fear  that  she  is  likely  to  do  so  again  and, 
if  she  does  not  overcome  the  belief,  is  likely  to  do 
so  if  the  occasion  she  fears  arises;  and,  if  a  person 
faints  frequently,  especially  in  childhood,  the 
habit  is  likely  to  be  formed  for,  as  previously  stated, 
pathways  are  formed  in  the  nervous  system,  by 
either  the  voluntary  or  involuntary  repetition  of 
acts,  which  increase  the  facility  with  which  a  per- 
son responds  to  any  stimulus  in  the  same  manner 
as  previously.  Thus,  it  can  be  seen  that,  while 
fainting  may  be  due  to  serious  conditions,  it  may 
merely  indicate  a  lack  of  self-control,  or  undue 
susceptibility  to  suggestion. 

Symptoms :  Before  fainting  a  person  is  likely  to 
experience  sensations  of  nausea  and  faintness  and 
to  be  conscious  of  roaring  and  ringing  sounds  in  the 


First  Aid  Treatment          267 

ears ;  her  face  becomes  pale  and  covered  with  per- 
spiration, her  pulse  grows  relatively  weak  and 
rapid  and  she  becomes  unconscious;  as  a  rule 
however  the  condition  is  of  short  duration. 

Treatment:  The  essential  feature  of  the  treat- 
ment is  to  facilitate  the  flow  of  blood  to  the  brain 
and,  if  a  person,  on  first  feeling  faint,  bends  forward 
until  her  head  is  about  on  a  level  with  her  knees, 
loss  of  consciousness  may  be  prevented.  If  this 
does  not  answer,  lay  her  on  her  back,  loosen  her 
clothing  and  if  she  is  indoors  open  a  window. 
Sprinkling  a  little  cold  water  on  the  face  may  be  of 
help  because  the  cold  gives  rise  to  nerve  impulses 
which  are  transmitted,  via  the  spinal  cord  and 
brain,  to  the  heart  and  blood-vessels.  Ammonia 
may  be  given  by  inhalation  when  the  patient  is 
conscious  or  by  mouth  in  the  doses  mentioned  on 
page  265.  A  drink  of  hot  tea  may  make  her  feel 
better,  because  the  heat  is  stimulant  and  tea 
contains  caffeine  which  stimulates  the  nervous 
system.  Coffee  also  contains  caffeine,  but  some 
people  when  nauseated  are  not  able  to  take  coffee, 
because  some  of  its  other  ingredients  sometimes 
tend  to  increase  this  condition. 

Hysteria 

Hysteria  is  a  term  applied  to  various  abnormal 
nervous  manifestations.  It  is  seen  usually  in 
persons  who  have  not  much  will-power  or  self- 
control,  though,  occasionally,  following  severe 


268  Nursing  Methods 

strain,  either  mental  or  physical,  even  a  person  of 
normal  mental  caliber  may  give  way  to  emotion 
of  an  hysterical  nature,  such  as  uncontrollable 
laughing  and  crying.  The  other  more  common 
phases  of  hysteria  are  simulated  fainting  and  con- 
vulsions, but  the  individual  does  not  lose  con- 
sciousness and,  if  she  is  left  alone,  she  will  usually 
promptly  recover,  while,  on  the  other  hand, 
attention  and  sympathy  are  likely  to  make  her 
worse. 

Treatment:  Leave  the  person  alone  and  see  that 
others  do  likewise.  In  the  case  first  mentioned  a 
dose  of  aromatic  spirits  of  ammonia  (see  page  265) 
may  be  given  or  a  drink  of  hot  tea  or  coffee. 

Sunstroke 

This  condition  is  produced  by  exposure  to  the 
rays  of  the  sun  or  to  extreme  heat  from  other 
sources,  especially  when  the  humidity  is  high.  As 
stated  in  the  Chapter  on  Ventilation,  heat  is  elimi- 
nated from  the  body  chiefly  by  radiation  from  the 
skin  and  by  the  evaporation  of  sweat  and,  if  both 
processes  are  interfered  with,  as  they  are  when  the 
atmosphere  is  both  hot  and  moist,  the  body  tem- 
perature may  rise  exceedingly  high.  The  author 
has  seen  patients  with  temperatures  of  120°  F. 
and  possibly  over,  as  this  was  as  high  as  the  ther- 
mometer registered. 

The  symptoms  are:  Unconsciousness,  the  face 
is  red,  the  skin  hot  and  dry,  the  pulse  full  and  slow, 


First  Aid  Treatment          269 

the  breathing  labored  and  sighing,  the  temperature 
rises  gradually  and,  unless  preventative  measures 
are  taken,  may  become  exceedingly  high  and  death 
is  then  likely  to  occur. 

The  usual  treatment  consists  in  putting  the 
patient  into  a  cold  bath  with  an  ice-cap  or  com- 
presses that  are  kept  very  cold  on  the  head,  or  if  a 
bath  cannot  be  obtained  the  patient  is  wrapped 
in  a  sheet  that  has  been  wet  with  cold  water  and  is 
kept  wet  by  sprinkling  it  with  cold  water.  It  must 
not  be  covered  because  it  is  only  by  the  evapora- 
tion of  the  water  that  it  will  be  sufficiently  cold. 
A  fold  of  the  wet  sheet  or  wet  towel  must  be  placed 
wherever  two  surfaces  of  the  body  come  together, 
as  between  the  legs  and  between  the  arms  and 
chest.  If  the  patient's  temperature  is  very  high 
the  doctor  is  likely  to  order  ice  rubbed  over  the 
sheet,  but,  except  in  extreme  cases  and  when  there 
is  delay  in  getting  a  doctor,  an  inexperienced 
person  should  not  resort  to  such  drastic  measures ; 
in  fact,  if  a  doctor  can  be  obtained  within  a  reason- 
able time  it  is  better  for  any  who  is  not  likely  to 
recognize  symptoms  of  shock,  to  merely  put  cold 
on  the  head,  bathe  the  neck  and  chest  and  get  the 
bath  or  sheets,  water  and  something  to  protect 
the  bed,  ready  for  use  when  the  doctor  comes. 
The  temperature  should  be  taken  by  rectum  or 
axilla  about  every  twenty  minutes  and  the  condi- 
tion of  the  pulse  ascertained  every  few  minutes. 
The  bath  is  discontinued  when  the  temperature 
falls  or  if  signs  of  shock  become  evident. 


270  Nursing  Methods 

Heat  Prostration 

The  term  heat  prostration  is  applied  to  a  condi- 
tion brought  about,  as  in  the  case  of  sunstroke,  by 
exposure  to  excessive  heat,  but  the  symptoms  are 
somewhat  different.  They  are:  The  patient  be- 
comes very  faint,  but  not  unconscious ;  the  face  is 
pale  and  the  skin  covered  with  perspiration;  the 
pulse  is  weak  and  rapid,  the  breathing  quick  and 
shallow ;  the  temperature  is  likely  to  rise  consider- 
ably above  normal  but  not  as  high  as  in  sunstroke. 

For  treatment  have  the  patient  lie  down  in  a 
cool  place,  put  cold  compresses  or  an  ice-cap  on 
the  head ;  give  the  patient  all  the  cold  water  that 
she  can  drink  and,  if  they  are  at  hand  a  dose  (see 
page  265)  of  aromatic  spirits  of  ammonia  and 
inhalations  of  ammonia  or  smelling  salts.  If  the 
patient  does  not  recover  promptly  or  the  symptoms 
are  at  all  severe  a  doctor  should  be  notified. 

Convulsions  and  Chills 

Convulsions  are  commonly  described  as  violent 
involuntary  contraction  of  the  skeletal  muscles 
(those  covering  the  skeleton  or  bony  framework  of 
the  body),  practically  all  these  muscles  may  be 
involved  or  only  those  on  one  side  of  the  body  or 
only  certain  groups  of  muscles. 

With  the  exception  of  those  due  to  epilepsy  or 
hysteria,  convulsions  are  almost  always  due  to 
excessive  stimulation  of  the  nervous  system.  They 


First  Aid  Treatment          271 

occur  more  readily  in  childhood  than  in  later  life, 
for  the  nervous  system  is  then  more  easily  in- 
fluenced and  very  trifling  irritation,  such  as  that 
due  to  the  presence  of  worms  in  the  intestine  or 
indigestible  food  in  the  stomach  or  intestine,  or 
intense  emotion  as  anger  or  fear  may  excite  the 
nervous  system  sufficiently  to  induce  a  convulsion. 
Common  sources  of  nerve-excitement  and  conse- 
quent convulsions,  in  both  adults  and  children  are : 

(1)  Pressure  on  some  part  of  the  brain  or  spinal 
cord,  as  when  there  is  a  fracture  of  the  skull  or 
spinal  column,  or  when  there  is  hemorrhage  into 
the  brain  and  a  clot  forms,  as  may  occur  from  an 
accident  or  in  the  condition  known  as  apoplexy; 

(2)  many  poisons,  both  those  ingested  and  those 
formed  within  the  body  as  described  on  page  263 ; 

(3)  anything  that  prevents  the  body  getting  suffi- 
cient oxygen. 

It  may  be  difficult  for  even  a  doctor  to  determine 
the  cause  of  convulsions,  but  nevertheless  it  is 
important  for  anyone  seeing  a  person  in  convul- 
sions to  try  and  ascertain  it  for  the  first-aid  treat- 
ment required  depends  upon  the  cause.  The  first 
points  to  be  considered  are :  Is  there  any  evidence 
that  poison  has  been  taken;  is  it  known  if  the 
patient  has  kidney  disease  (in  which  case  the  con- 
vulsions are  probably  due  to  a  condition  known  as 
uremia);  is  there  any  history  of  previous  convul- 
sions, this  would  suggest  hysteria  or  epilepsy;  has 
the  patient  been  subjected  to  unusual  strain,  either 
mental  or  physical,  this  in  an  elderly  person,  and 


272  Nursing  Methods 

associated  with  the  symptoms  described  later 
would  suggest  apoplexy.  If  the  patient  is  a  child, 
further  questions  to  be  asked  are:  What  it  has 
eaten,  if  it  has  shown  any  evidence  of  having  worms 
or  been  exposed  to  an  infectious  disease  recently. 

Also,  there  are  certain  differences  in  the  symp- 
toms produced  by  some  of  the  causes  of  convul- 
sions, that  may  aid  in  determining  the  cause,  for 
examples : 

In  hysteria  the  patient  is  not  unconscious  and 
takes  care  not  to  hurt  herself. 

Before  a  convulsion  due  to  epilepsy  the  patient 
generally  gives  a  sharp  cry  and  falls  unconscious. 
The  muscles  are  at  first  stiff  and  rigid,  but  are  soon 
thrown  into  violent  contractions,  the  muscles  of 
the  jaws  are  involved  so  that  there  is  danger  of  the 
patient  biting  her  tongue  and  the  excessive  move- 
ment stimulates  the  secretion  of  saliva  to  such  an 
extent  that  there  is  foaming  at  the  mouth. 

When  the  convulsions  are  due  to  the  conditions 
existing  in  uremia  (in  which  the  kidneys  are  not 
eliminating  the  waste  products  of  metabolism), 
there  is  usually  an  odor  of  urine  to  the  breath,  the 
face  is  likely  to  be  flushed,  the  breathing  is  of  a 
snoring  character,  the  pulse  is  full  and  strong. 

The  symptoms  of  apoplexy1  are  very  similar  to 
those  of  uremia  except  that  (i)  there  is  no  odor  of 
urine  to  the  breath;  (2)  the  pupils  of  the  eyes  are 
usually  dilated  and  of  unequal  size  and  (3)  there  is 
.usually  paralysis  of  the  part  of  the  body  that  re- 

1  Apoplexy  is  due  to  the  rupture  of  blood-vessels  in  the  brain. 


First  Aid  Treatment          273 

ceives  nerve  impulses  from  the  portion  of  brain 
upon  which  the  clotted  blood  is  pressing. 

Convulsions  due  to  injury  of  the  brain  as  the 
result  of  fracture  of  the  skull  are  generally  asso- 
ciated with  symptoms  similar  to  those  of  apoplexy, 
except  that  the  face  is  likely  to  be  pale  and  there 
may  be  hemorrhage  from  the  ears,  eyes,  nose,  and 
mouth,  and  signs  of  injury  to  the  skull. 

Convulsions  due  to  ingested  poisons  are  asso- 
ciated with  other  symptoms  induced  by  the 
poisons  as  described  under  Poisoning. 

It  is  very  important  to  notice  if  all  parts  of  the 
body  are  convulsed,  and  if  not,  which  parts  are, 
for  this  knowledge  often  helps  the  physician  deter- 
mine the  cause  of  a  convulsion,  and  the  convulsion 
may  cease  before  he  arrives. 

Treatment:  For  convulsions  due  to  the  hysteria, 
as  previously  stated,  leave  the  patient  alone,  but 
watch  to  see  that  she  does  not  injure  herself, 
though  she  is  not  likely  to  do  so.  When  the  con- 
vulsions are  known  to  be  epileptic  it  is  usually 
better  to  leave  the  patient  on  the  ground  and  the 
only  treatment  required  is :  (i)  To  put  something 
soft,  as  the  edge  of  a  folded  towel  between  the 
teeth  at  one  corner  of  the  mouth,  so  as  to  keep  the 
jaws  apart  to  prevent  the  tongue  being  bitten; 
and  (2)  to  loosen  tight  bands.  Do  not  try  to  re- 
strain the  patient's  movements,  for,  by  so  doing, 
you  may  injure  her,  but  see  that  she  does  not  strike 
against  anything.  If  it  is  not  positively  known 
that  the  convulsion  is  epileptic,  or  if  it  lasts  much 

18 


274  Nursing  Methods 

longer  than  preceding  ones,  or  there  are  unusual 
symptoms,  notify  the  doctor.  For  convulsions 
due  to  other  causes,  send  for  the  doctor  imme- 
diately; take  the  means  just  described  to  prevent 
the  patient  biting  her  tongue ;  loosen  tight  clothing, 
remove  the  cause  of  the  convulsion,  if  possible; 
keep  the  patient  lying  down  with  her  head  slightly 
elevated ;  put  cold  compresses  or  an  ice-cap  on  the 
head  and  watch  that  she  does  not  injure  herself 
by  knocking  against  anything.  If  the  patient  is  a 
child  put  her  into  a  bath  with  a  temperature  about 
105°  F.,1  keep  the  cold  application  on  her  head. 
After  about  fifteen  or  twenty  minutes,  remove  the 
child  from  the  bath  and  place  her  between  soft 
blankets ;  do  not  use  too  many  covers  for  the  child 
must  not  be  too  warm,  but  avoid  any  danger  of 
chilling.  Keep  the  room  fairly  dark  and  the  child 
as  quiet  as  possible.  If  the  convulsion  was  due 
to  anything  that  the  child  has  eaten  the  doctor 
usually  prescribes  a  dose  of  castor  oil  and  an  enema, 
and  only  allows  water,  or  possibly  whey,  to  be 
given  by  mouth  for  at  least  twenty-four  hours. 

Chills,  like  convulsions,  consist  of  involuntary 
contractions  of  voluntary  muscles,  but  the  con- 

1  As  a  thermometer  can  seldom  be  obtained  in  emergency  it  is 
well  for  the  pupils  to  test  water  of  this  temperature  with  their 
arms  for  it  is  important  that  the  water  used  for  a  bath  to  arrest 
convulsions  should  be  about  this  temperature,  for,  if  it  is  much 
below  105°,  it  is  not  likely  to  have  much  effect  and,  if  it  is  much 
hotter,  it  will  interfere  with  heat  elimination  and  as,  during  con- 
vulsions, there  is  excessive  heat  formation  in  the  body,  it  is  most 
important  not  to  hinder  its  loss. 


First  Aid  Treatment          275 

tractions  are  less  intensive  and  the  condition  is  not 
necessarily  associated  with  loss  of  consciousness. 
Chills  are  due  to  the  same  causes  as  convulsions 
and  to  exposure  to  cold.  They  occur  most  fre- 
quently in  adult  life  because  a  degree  of  nerve 
excitement  that  induces  a  chill  in  an  adult  is  likely 
to  create  a  convulsion  in  a  child  and,  the  younger 
the  child,  the  more  likely  is  this  to  be  the 
case. 

The  symptoms  vary  somewhat  with  the  intensity 
of  the  chill :  there  may  be  merely  chilly  sensations 
and  slight  shivering  or  the  teeth  may  chatter  and 
the  shivering  become  so  intense  that  the  move- 
ments are  almost  convulsive  and,  in  such  case,  the 
lips  will  become  blue  and  the  skin  pale  because  the 
blood-vessels  near  the  surface  of  the  body  will  be 
contracted  and  the  blood  thus  forced  to  the  in- 
terior of  the  body.  Following  such  a  chill  there  is 
likely  to  be  a  considerable  rise  of  temperature, 
especially  if  it  occurs  in  the  course  of  an  infec- 
tious disease,  because  muscular  contractions 
increase  the  oxidative  processes  which  are  the 
chief  source  of  heat  in  the  body  and,  also, 
whatever  causes  the  chill  is  likely  to  affect  the 
temperature,  especially  if  bacteria  are  the  active 
agent. 

Treatment:  If  the  chill  is  at  all  severe,  get  the 
patient  to  bed  as  quickly  as  possible,  wrap  her  in 
blankets  and  put  hot-water  bags  around  her. 
Remove  the  blankets  and  hot-water  bags  as  soon 
as  she  stops  shivering  and  if,  as  is  likely  to  be  the 


276  Nursing  Methods 

case,  she  has  a  headache,  put  cold  compresses  or  an 
ice-cap  on  her  head.  Take  her  temperature  and 
if  it  is  more  than  a  degree  or  two  above  normal 
notify  a  doctor,  because  a  chill  is  one  of  the  first 
symptoms  at  the  onset  of  a  number  of  serious  dis- 
eases, such  as  pneumonia,  influenza,  scarlet  fever, 
and  measles. 

The  usual  treatment  for  slight  chilling,  especially 
following  exposure  to  cold,  is  to  take  a  hot  bath  and 
hot  drinks,  especially  hot  lemonade,  and  a  dose  of 
aspirin  (five  or  ten  grains  for  an  adult,  two  or  five 
for  a  child  between  twelve  and  sixteen  (children 
younger  than  twelve  years  should  not  be  given  such 
drugs  without  a  doctor's  order)  and  go  to  bed. 
Care  must  be  taken  to  keep  warm  after  this  treat- 
ment because  the  aspirin,  hot  bath,  and  drink  will 
cause  free  perspiration,  and  exposure  to  cold  or  a 
draft  may  hasten  the  evaporation  of  sweat  to  such 
a  degree  that  the  body  will  be  chilled  and  the  con- 
dition which  the  treatment  is  used  to  cure  made 
worse.  This  condition  consists  of  congestion  of  the 
membrane  of  the  air  passages  and,  possibly,  of  other 
internal  organs.  Congestion  in  the  air  passages 
(throat,  nose,  bronchial  tubes,  lungs)  favors  the 
activity  of  the  various  species  of  bacteria  that 
cause  colds  and  the  treatment,  by  increasing  per- 
spiration (and  thus  taking  fluid  from  the  blood) 
and  increasing  the  amount  of  blood  in  the  skin, 
lessens  the  internal  congestion  and  is  therefore 
likely  to  abort  the  cold. 


First  Aid  Treatment          277 

Demonstration  25 

Lifting  an  Unconscious  Patient  from  the  Floor  and 
the  Treatment  for  Fainting,  Shock,  Chills, 
and  Convulsions 

Procedures  similar  to  those  for  this  demonstra- 
tion have  been  described  in  previous  lessons  and, 
therefore,  with  the  exception  of  lifting  a  patient 
from  the  ground,  the  pupils  should  be  able  to  carry 
out  the  instructions  given  in  the  preceding  pages 
without  further  explanation.  The  doll  can  be  used 
for  the  treatment  of  a  child  with  convulsions  but 
some  of  the  pupils  should  act  as  subjects  for  the 
other  procedures,  one  pretending  to  faint,  another 
to  be  in  shock,  another  to  be  having  a  chill,  and 
another  a  convulsion;  those  pretending  to  be  in 
shock  and  to  be  having  a  convulsion  should  lie  on 
the  floor  that  they  may  be  lifted  and  carried  to  bed. 
Other  pupils  should  demonstrate  the  treatment 
and  should  act  as  though  the  emergencies  were 
real,  putting  into  effect  the  instruction  given  under 
principles  of  first-aid  treatment,  as  well  as  that  for 
the  special  emergency,  and  also  the  instruction 
given  in  Chapter  II  regarding  lifting  and  carrying 
patients. 

To  lift  a  patient  from  the  ground:  Two  pupils 
crouch  by  the  patient,  on  the  same  side,  your  feet 
planted  firmly  on  the  floor,  your  knees  bent  suffi- 
ciently to  make  you  low  enough  to  pass  your  arms 
readily  under  the  patient.  If  the  latter  is  supposed 


278  Nursing  Methods 

to  have  convulsions  or  to  be  suffering  from  injury 
to  the  brain,  let  the  taller  of  the  two  lifters  be  the 
one  to  support  the  head,  but,  for  the  patient  in 
shock  let  the  shorter  of  the  two  take  the  head. 
As  usual,  one  lifter  is  to  give  directions.  Be  sure 
that  your  skirts  will  not  be  in  your  way  when  you 
rise.  Let  the  lifter  at  the  head  pass  one  of  her 
arms  under  the  patient's  shoulders  to  the  further 
armpit,  and  the  other  under  the  small  of  the  back, 
while  the  other  lifter  passes  one  of  her  arms  under 
the  patient's  hips  and  the  other  under  her  knees. 
At  word  from  the  director,  lift  the  patient  unto 
your  knees.  Readjust  your  hold,  make  sure  that 
there  is  nothing  in  your  way  and,  following  the 
directions  given  in  Chapter  II,  carry  the  patient 
to  the  bed. 


CHAPTER  XII 

Asphyxia  or  Suffocation.    Artificial 
Respiration 

Mechanism  of  breathing.  Nature,  common  causes  and  treat- 
ment of  asphyxia.  Demonstration  26.  Artificial  respiration  and 
treatment  of  an  individual  rescued  front  drowning. 

Equipment  for  demonstration:  (i)  A  lungmotor 
if  possible. 

(2)  Blankets  or  old  coats  or  other  substitutes  to 
put  under  the  chest  as  in  Fig.  76. 

Review  of  the  mechanism  of  breathing :  In  the 
portion  of  the  brain  known  as  the  medulla  oblon- 
gata  there  is  a  small  area  called  the  respiratory 
center  from  which  impulses  pass  over  nerve  fibers 
to  the  muscle  tissue  in  the  diaphragm  and  to  the 
muscles  which  move  the  chest  wall.  These  im- 
pulses are  the  result  of  the  stimulation  of  the  center 
by  the  carbon  dioxid  carried  through  it  by  the 
blood.  The  carbon  dioxid  is  formed  in  the  tissues 
by  the  oxidation  of  substances  derived  from  food 
that  has  been  eaten,  digested, absorbed, and  carried 
to  the  tissues  by  the  blood.  The  impulses  dis- 
charged into  the  muscle  tissue  make  it  contract, 
and  this  results  in  the  diaphragm  being  pulled 
down  and  the  ribs  being  pulled  outward  and  up- 

279 


280  Nursing  Methods 

ward  so  that  the  chest  cavity  becomes  considerably 
enlarged.  The  elastic  lung  tissue  expands  in  keep- 
ing with  the  chest  walls  and  this  causes  a  partial 
vacuum  in  its  little  air  sacs  and  in  the  passages 
leading  to  them  (the  bronchial  tubes  and  bron- 
chioles)1 and  then  the  pressure  of  the  air  around 
the  body  is  much  greater  than  in  the  air  sacs  and 
passages  and  therefore,  air  is  forced  into  the  air 
tubes  and  sacs.  The  expansion  of  the  chest  is 
immediately  followed  by  its  contraction  and  some 
of  the  air  is  then  pressed  out.  The  air  forced  into 
the  air  sacs  during  inspiration  (the  period  in  which 
the  chest  expands) ,  contains  more  oxygen  and  less 
carbon  dioxid  than  there  is  in  the  blood  and  thus, 
as  gases  always  tend  to  spread  out  through  space 
and  are  able  to  pass  through  the  very  thin  walls  of 
the  air  sacs  and  the  small  blood-vessels  in  the  lungs, 
oxygen  passes  into  the  blood  and  the  carbon  dioxid 
brought  from  the  tissues  leaves  the  blood  and  is 
exhaled  during  expiration  (the  period  in  which  the 
chest  contracts).  The  oxygen  inhaled  unites  with 
a  substance,  known  as  hemoglobin,  that  is  con- 
tained in  the  red  corpuscles  of  the  blood,2  but  the 
combination  is  not  very  stable  and  as  the  blood 

1  If  the  pupils  have  not  studied  physiology,  they  should,  if 
possible,  be  shown  the  lungs  of  sheep  or  calves  and  allowed  to 
blow  them  up  and  dissect  them. 

1  The  combination  of  hemoglobin  and  oxygen  is  known  as  oxy- 
hemoglobin.  This  is  of  a  red  color  and,  therefore,  the  blood  in  the 
arteries  is  red  but  that  in  the  veins  has  a  bluish  tinge,  the  color  of 
the  hemoglobin  when  not  combined  with  oxygen,  because  much 
of  the  oxygen  has  left  the  blood  before  it  reaches  the  veins. 


Asphyxia  of  Suffocation       281 

passes  through  the  tissues  where  there  is  no  free 
oxygen  that  in  the  red  cells  passes  out  of  the  blood- 
vessels into  the  tissues  and  is  used  for  the  oxida- 
tive  processes  necessary  to  supply  the  body  with 
heat  and  energy.  The  compounds  with  which 
oxygen  unites  are  decomposed  and  one  of  the  waste 
products  of  the  decomposition  is  the  carbon  dioxid 
which  passes  through  the  capillaries  and  lymph 
vessels  and  is  thus  taken  to  the  veins  and  is  finally 
eliminated,  as  previously  stated,  through  the  lungs. 
Asphyxia  or  suffocation  is  a  condition  induced 
by  an  insufficient  supply  of  oxygen  in  the  body. 
The  insufficiency  may  be  due  to  many  causes, 
some  of  the  more  common  ones  being:  (i)  An 
insufficient  supply  of  oxygen  in  the  air,  as  at  high 
altitudes  and  in  improperly  ventilated  mines.  (2) 
Obstruction  to  the  entrance  of  air  to  the  lungs  as 
by  (a)  swelling  of  the  throat  or  other  air  passages 
such  as  occurs  in  many  diseases,  but  particularly 
diphtheria,  and  as  the  result  of  injury  to  the  tissues 
by  irritating  gases  or  corrosive  liquids;  (b)  the 
entrance  of  foreign  substances  into  the  air  passages 
or  (e)  external  pressure  upon  the  trachea  (wind- 
pipe). (3)  Inflammation  of  the  lungs.  (4)  In- 
terference with  the  circulation  of  blood  through 
the  lungs.  (5)  Water  in  the  lungs — as  occurs  in 
drowning.  (6)  The  inhalation  of  certain  gases, 
especially  carbon  monoxid  (one  of  the  constituents 
of  illuminating  gases) ,  which  unite  with  the  hemo- 
globin of  the  blood  and  thus  prevent  it  absorbing 
oxygen.  (7)  The  destruction  of  the  red  cells  of 


282  Nursing  Methods 

the  blood  by  poisons.  It  is  by  this  means  that  the 
venom  of  certain  snakes  causes  death.  (8)  De- 
pression of  the  part  of  the  nervous  system  which 
moves  the  muscles  responsible  for  breathing. 

The  symptoms  of  asphyxia  vary  somewhat 
according  to  the  degree  of  suffocation  and  its  cause, 
but  there  will  be  discoloration  of  the  skin,  es- 
pecially that  of  the  face,  it  may  be  of  a  bluish  tinge 
or,  in  extreme  cases,  a  deep  reddish  purple;  the 
breathing  is  likely  to  be  labored  and  gasping  but 
when  the  asphyxia  is  due  to  depression  of  the 
nervous  system,  the  breathing  may  become  very 
slow  and  weak  and  cease  suddenly  and,  when  the 
condition  is  associated  with  drowning,  or  hanging, 
or  collapse  it  may  be  almost  impossible  to  tell  if  the 
individual  is  breathing ;  if  the  asphyxia  is  profound 
there  will  be  loss  of  consciousness  and  probably 
convulsions. 

The  treatment  consists  in  removing  the  cause  if 
possible,  placing  the  patient  where  she  will  get 
fresh  air,  but  keeping  her  warm;  giving  artificial 
respiration  if  necessary.  Needless  to  say  a  doctor 
must  be  sent  for  at  once  and,  if  possible,  a  lung- 
motor.  Such  appliances  are  usually  obtained  from 
hospitals,  stores  where  surgical  supplies  are  sold, 
and  the  emergency  stations  at  bathing  beaches. 

Artificial  Respiration 

Artificial  respiration  consists  in  making  the 
chest  wall  alternately  contract  and  expand  in  as 


Artificial  Respiration          283 

nearly  the  same  manner  as  in  natural  breathing  as 
possible.  The  easiest  method  of  giving  artificial 
respiration  when  a  lungmotor  cannot  be  obtained 
is  that  known  as  the  Schaefer  method. 

To  carry  out  the  Schaefer  method  proceed  as 
follows :  Lay  the  patient  prone  on  the  ground  with 
a  pillow  or  substitute  under  the  lower  part  of  the 


Pressure  on  expiration 


Pressure  off  inspiration 
Fig.  76.     Schaefer  method  of  artificial  respiration. 

chest,  her  head  turned  on  one  side  and  her  arms 
stretched  above  it.     Kneel  across  the  patient's 


284  Nursing  Methods 

thighs,  facing  her  head ;  place  your  hands  flat  over 
the  lower  part  of  her  back,  covering  the  lower  ribs 
with  your  fingers  pointing  toward  the  sides;  lean 
forward  forcibly,  throwing  the  weight  of  your  body 
upon  your  hands,  thus  making  all  possible  pressure 
upon  the  patient's  back;  do  this  gradually  and 
slowly  (this  movement  which  is  a  substitute  for 
expiration  will  force  air  and,  if  it  is  present,  water 
from  the  lungs);  then,  as  gradually,  relax  your 
pressure  by  slowly  straightening  your  back,  but 
keep  your  hands  in  position.  Repeat  these  move- 
ments of  alternate  pressure  and  relaxation  at  a 
rate  that  will  allow  of  about  sixteen  (the  two  move- 
men  ts  being  counted  as  one)  being  made  per 
minute. 

Important  points  to  remember  in  connection 
with  artificial  respiration  are :  (i)  The  movements 
are  not  to  be  quicker  than  those  of  ordinary  breath- 
ing. (2)  Unless  it  is  positively  known  that  the 
individual  is  dead,  artificial  respiration  should  be 
maintained  for  about  an  hour  because,  though 
recovery  is  hardly  likely  if  breathing  has  ceased 
for  more  than  five  minutes,  it  has  occurred  when 
the  person  has  been  under  water  a  much  longer 
time  and  apparently  has  not  begun  to  breathe  for 
a  very  considerable  time  after  artificial  respiration 
has  been  commenced.  (3)  Even  after  natural 
breathing  has  started,  it  may  cease  suddenly  and, 
therefore,  the  patient  should  not  be  left  alone  for 
an  hour  or  more.  (4)  Pneumonia  is  a  very  com- 
mon sequela  of  conditions  necessitating  artificial 


Artificial  Respiration          285 

respiration,  and  anything  (e.g.,  damp  clothing) 
that  will  also  favor  the  development  of  this  disease 
should  be  removed  as  quickly  as  possible.  If  after 
a  person  has  been  rescued  from  drowning  it  is  im- 
possible to  undress  her  at  once,  something  dry 
should  be  put  over  her  to  retard  evaporation  and 
consequent  chilling  of  the  body  and,  as  soon  as 
help  can  be  obtained,  even  while  artificial  respira- 
tion is  being  given,  she  should  be  undressed  and 
rolled  in  dry  blankets  or  substitutes  and  treated 
for  shock. 

Demonstration  26 

Treatment  of  a  Person  Rescued  from  Drowning 
Artificial  Respiration 

Procedure:  Let  some  of  the  pupils  be  subjects 
and  the  others  give  the  treatment,  they  should 
act  as  though  the  emergency  were  real. 


.  v/  *•  - 

Fig.  77.    Emptying  water  from  the  lungs. 


286  Nursing  Methods 

Let  each  one,  as  quickly  as  possible  (i)  see  if 
there  is  any  seaweed  in  her  patient's  mouth,  and 
pretend  to  (2)  loosen  tight  bands.  (3)  Turn  the 
patient  prone  on  the  ground,  pass  the  hands  under 
her  abdomen  and  raise  her  as  in  Fig.  77,  to  further 
the  flow  of  water  from  the  lungs. 
(4)  Place  the  patient  prone  on  the  ground  with  her 
head  turned  on  one  side ;  throw  something  dry  over 
her,  your  own  coat  if  necessary,  and  proceed  with 
artificial  respiration  as  previously  described. 


CHAPTER  XIH 
Wounds 

The  nature,  classification,  means  of  repair,  and  common  com- 
plications of  wounds.  Causes  of,  and  means  of  preventing,  the 
infection  of  wounds.  First  aid  treatment  of  wounds.  Demonstra- 
tion 27:  Dressing  a  wound. 

Equipment  for  demonstration :  The  first  aid  box. 

Boiling  water. 

Clean  towels. 

Toilet  basin  and  water,  hot  and  cold,  for  the 
hands. 

Paper  bag  or  other  receptacle  for  soiled  pledgets, 
etc. 

Nature  and  Classification  of  Wounds 

A  wound  is  usually  defined  as  a  break  in  the  con- 
tinuity oj  body  tissue  caused  by  violence  or  inten- 
tional cutting. 

According  to  their  nature  wounds  are  classified 
as: 

i .  Incised  wounds,  i.e. ,  those  in  which  the  edges 
are  clean  cut  and  there  is  no  tearing  of  the  tissues. 
Such  wounds  are  made  with  a  sharp  instrument  as 
a  knife. 

287 


288  Nursing  Methods 

2.  Contused  wounds,  i.e.,  those  associated  with 
contusion1  or  bruising  of  the  tissues.    The  edges  of 
such  wounds  are  usually  crushed  and  jagged.    A 
wound  of  this  kind  is  generally  made  by  a  blow 
from  a  heavy  object  or  a  fall. 

3.  Lacerated  wounds;  in  these  the  edges  are 
torn  and  mangled.    These  are  the  kind  of  wounds 
likely  to   be  produced  in   accidents   caused   by 
machinery. 

4.  Punctured  wounds;  in  these  the  wound  is 
deep  in  proportion  to  its  diameter  and  it  has  but  a 
small  opening.     Such  wounds  are  produced  by 
pointed  objects  as  nails,  daggers,  etc.,  and,  some- 
times, by  bullets. 

Wounds  are  also  classified  according  to  their 
origin  (e.g.,  operative  wounds,  gunshot  wounds,  etc.) 
and  depending  upon  their  freedom  from,  or  contami- 
nation with,  bacteria,  as  asceptic  and  infected  wounds. 

Aseptic  wounds  are  defined  as  wounds  which  are 
sufficiently  free  from  microorganisms  to  show  no 
symptoms  of  infection,  and  infected  wounds,  as 
wounds  which  are  invaded  by  organisms  sufficient  in 
number  and  virulence  to  produce  pathological  symp- 
toms. 

Allied  to  wounds,  though  not  usually  thus  classi- 
fied, are  the  open  sores  such  as  ulcers,  pressure 
sores,  and  those  caused  by  some  forms  of  eczema 
and  other  skin  diseases. 

*  A  contusion  is  a  wound,  associated  with  rupture  of  blood- 
vessels, beneath  the  skin.  The  discoloration  is  due  so  the  extrava- 
sation of  blood  into  the  tissues. 


Wounds  289 

Healing  of  Wounds 

Four  processes  by  which  the  body  endeavors  to 
repair  wounds  in  its  tissues  are :  Fighting  infection ; 
the  disintegration  and  removal  of  debris,  such  as 
blood-clots  and  destroyed  tissue  cells;  the  proli- 
feration of  new  cells ;  and,  when  possible,  the  seal- 
ing together  of  the  walls  of  the  wound. 

Conditions  favorable  for  these  processes  are 
promoted  by  the  injury;  three  of  which  are:  (i) 
Blood  escapes  from  the  severed  vessels  and  this 
helps  to  wash  out  foreign  substances,  including 
bacteria,  that  have  entered  the  wound.  (2)  The 
blood-vessels  in  the  part  become  dilated  and  this 
interferes  with  the  passage  of  blood,  consequently 
an  unusual  amount  of  blood-plasm  passes  through 
the  walls  of  the  capillaries  and,  with  it,  white  blood- 
cells  known  as  phagocytes1  which  can  either  dis- 
integrate or  demolish  small  blood-clots,  dead  tissue 
cells,  and  bacteria  remaining  in  the  wound.  This 
plasm  or  lymph  also  supplies  the  extra  food  mater- 
ial* necessary  for  the  growth  of  the  new  cells  re- 
quired to  replace  those  destroyed  and,  as  the  plasm 
is  of  a  glutinous  nature,  it  helps  to  hold  the  walls 
of  the  wound  together  if  they  are  brought  into 
apposition.  (3)  The  third  important  effect  of  the 

1  From  the  Greek  phagein  =  to  eat  and  kytos  =  a  hollow  vessel. 

1  If  the  congestion  becomes  so  severe  that  the  flow  of  fresh 
blood  through  the  wound  is  interfered  with,  the  food  supply  for  the 
cells  is  limited,  therefore  the  prevention  of  all  unnecessary  irrita- 
tion and  interference  with  the  circulation,  as  by  tight  bandages, 
is  one  of  the  very  essential  considerations  in  the  care  of  wounds. 


290  Nursing  Methods 

injury   is   the   stimulation   of    the   reproductive 
faculty  of  the  cells. 

Reproduction  of  cells :  All  the  tissues  of  the  body 
are  composed  of  cells  and  what  is  known  as  intra- 
cellular  substance,  which  is  secreted  by  the  cells. 
In  the  beginning  of  life  the  body  grows  because  the 
cells  absorb  nutriment  from  the  lymph1  increase 
in  size  and  then  divide,  thus  forming  new  cells. 
The  cells  of  some  tissues,  especially  those  of  the 
skin,  blood,  blood-vessels  and  fibrous  tissue,2  re- 
tain this  power  of  reproduction  all  through  life, 
but  others,  especially  those  of  muscle  and  nerve 
tissue,  lose  it  to  a  great  extent,  even  before  body 
development  ceases,  and  then  their  growth  de- 
pends upon  increase  in  the  size  of  the  cells  and  the 
deposition  of  intracellular  substance.  Therefore, 
when  a  wound  is  made  in  muscle  tissue,  except  in 
very  early  youth,  the  destroyed  muscle  cells  are 
not  replaced,  but  new  cells  arise  from  the  fibrous3 
tissue  that  is  present  in  the  walls  of  the  wound, 

1  The  material  which  exudes  from  the  blood-vessels  into  the 
tissues. 

2  Fibrous  tissue,  in  the  form  of  bands  (ligaments)  and  cords 
'tendons)  holds  the  bones  together  at  their  joints  and  the  muscles 
to  the  bones  and,  in  the  form  of  thin  sheets,  it  exists  to  some  ex- 
tent in  almost  all  the  soft  tissues  of  the  body,  either  affording  a 
foundation  for  their  cells  or  holding  the  substance  of  the  tissue 
together  and  different  tissues  to  each  other.    If  the  skin  or  fat  is 
raised  from  a  piece  of  meat  and  the  flesh  of  the  meat  pulled  apart 
this  fibrous  tissue  will  be  seen  as  thin  white  strands. 

3  A  form  of  fibrous  tissue,  known  as  areolar  tissue  holds  the 
muscle  cells  together.    Also  it  holds  different  tissues  together 
and  thus  it  exists  in  all  parts  of  the  body. 


Wounds  291 

and  from  the  cells  of  the  skin  around  the  edges  of 
the  wound,  and  from  the  cells  of  the  injured  blood- 
vessels. The  new  cells  arising  from  the  blood- 
vessels form  small  loops  of  capillaries  that  extend 
into  the  wound  and  thus  the  new  fibrous  tissue 
and  skin  are  supplied  with  blood.  In  an  open 
wound  the  new  capillaries  and  cells  give  the  walls 
of  the  wound  a  rough  granular  appearance  and 
they  are  therefore  called  granulations. 

During  the  first  stages  of  healing  the  new  fibrous 
tissue  cells  are  relatively  large  and  soft,  but  they 
gradually  contract  and  harden,  and  thereby  press 
upon  the  newly  formed  blood-vessels  and  cause 
their  obliteration.  These  effects  result  in  the  new 
tissue  becoming  hard  and  inelastic  and  gradually 
losing  the  red  color  that  is  characteristic  of  new 
tissue  while  it  is  plentifully  supplied  with  blood. 
Eventually  the  part  becomes  whiter  than  the  sur- 
rounding skin.  The  mark  thus  left  is  known  as  the 
scar  or  cicatrix. 

The  amount  and  degree  of  hardness  of  scar 
tissue  that  will  form  following  a  wound  depends 
upon  several  factors;  important  ones  are: 

1.  The  nature  of  the  wound :  Naturally  a  small, 
aseptic,  incised  wound  will  heal  more  rapidly  than  a 
large  wound,  or  one  in  which  tissue  has  been  des- 
troyed by  the  processes  associated  with  infection, 
or  one  in  which  the  edges  are  torn  or  contused. 

2.  How  soon  the  walls  of  the  wound  are  brought 
together:  Immediately  following  injury  the  con- 
ditions are  more  favorable  for  agglutination  than 


292  Nursing  Methods 

later,  and  the  more  firmly  the  walls  adhere,  the 
less  the  amount  of  new  tissue  required. 

3.  The  age  of  the  individual:  In  youth,  while 
tissue  growth  is  still  in  progress,  a  wound,  other 
conditions  being  equal,  will  heal  more  rapidly  than 
in  adult  life,  and  there  is  always  a  chance  of  the 
reproduction  of  some  muscle  cells  and  of  the  fibrous 
tissue  remaining  relatively  pliable.    In  old  age,  on 
the  contrary,  scar  tissue  is  likely  to  become  very 
dense  and  inelastic. 

4.  The  vitality  of  the  part:  If  the  person's 
health  is  poor  at  the  time  the  wound  is  received  or 
if  anything  interferes  with  the  circulation  of  blood 
to  the  wounded  part,  healing  is  likely  to  be  delayed. 

The  more  common  causes  of  interference  with  the 
circulation  are  a  tight  bandage  and  excessive  con- 
gestion in  the  wound.  Excessive  congestion  is 
likely  to  occur  if  the  wounded  part  is  not  kept  at 
rest  or  if  its  position  favors  the  flow  of  blood  into 
and  not  from  the  part,  for  example,  if  the  wound 
is  in  the  hand  and  this  is  allowed  to  hang  down- 
ward. 

A  large  scar  is  unsightly  and,  furthermore,  if  it 
extends  deeply  into  the  tissues,  it  may,  by  its  con- 
traction, cause  a  deformity  that  will  seriously 
interfere  with  the  movement  of  the  part,  this  is 
especially  likely  to  be  the  case  if  the  wound  is  near 
a  joint. 

Another  factor  of  importance  in  the  results  of 
wounds  is  the  presence  or  absence  of  injury  to  other 
tissue  than  muscle,  e.g.,  tendons  or  nerves.  If 


Wounds  293 

either  a  tendon  or  nerve  is  cut  the  severed  ends 
should  be  sewn  together  by  a  doctor  at  once  for, 
if  much  time  is  allowed  to  elapse,  the  ends  will  re- 
tract and  then  some  part  below  the  injury  may  be 
useless  for  ever  more. 

Thus,  the  chief  points  to  be  considered  in  the 
first  aid  treatment  of  wounds  are :  (i )  The  preven- 
tion of  infection,  this  is  important  with  the  smallest 
of  wounds,  even  a  pin  prick.  (2)  If  the  wound  is 
at  all  deep1  it  is  to  be  inspected  by  a  doctor,  this  is 
especially  important  if  it  has  been  made  by  a  dirty 
object,  or  one  that  has  been  near  a  stable  or  man- 
ured soil,2  or  if  a  tendon  or  nerve  seems  to  in- 
volve in  the  injury — this  is  particularly  likely  to 
be  the  case  in  deep  wounds  of  the  wrist,  hand  or 
fingers.  (3)  If  the  sides  of  the  wound  gape,  or  a 
part  (e.g.,  the  tip  of  a  finger)  is  cut  away,  means 
should  be  taken  to  keep  the  raw  flesh  together  and, 
especially  in  the  latter  case,  a  doctor  should  be 
seen  immediately  so  that  the  parts  can  be  sutured ; 
if  this  is  done  soon  after  the  injury  occurs  and 

1  Deep  wounds  are  always  more  likely  to  be  infected  than  super- 
ficial ones  because:  (i)  They  are  harder  to  clean:  (2)  some  of  the 
most  virulent  microorganisms  that  infect  wounds  thrive  better 
when  they  are  out  of  contact  with  air. 

1  The  germ  that  causes  tetanus  (lockjaw)  is  a  normal  habitat  of 
the  intestines  of  some  animals,  especially  horses,  and  thus  wounds 
acquired  under  the  conditions  mentioned  above  are  particularly 
dangerous.  Wounds  made  with  fire-crackers  and  toy  pistols  have 
frequently  resulted  in  tetanus,  because  of  the  soil  on  the  hands 
when  the  wounds  were  made  and,  in  the  accident,  the  soil  and 
germs  are  driven  deeply  into  the  flesh,  away  from  the  air,  which  is 
favorable  for  the  tetanus  bactlit. 


294  Nursing  Methods 

there  is  no  infection  the  severed  parts  are  likely  to 
grow  together  readily.  The  treatment  of  hemor- 
rhage and  other  common  complications  of  wounds 
will  be  found  in  Chapter  XIV. 

Important  means  of  preventing  infection  are: 
(i)  To  let  the  wound  bleed  freely.1  If  it  does  not 
do  so  the  part  should  be  held  in  a  position  to  en- 
courage bleeding2  and  pressure  made  from  above 
downward,  toward  the  wound;  this  is  particularly 
necessary  after  pricks  such  as  are  made  with  pins 
or  needles,  because  in  such  cases  it  is  generally  the 
'only  preventive  measure  taken,  and  exceedingly 
bad  infections  have  been  contracted  by  pricks 
from  pins  and  needles  infected  with  bacteria.  (2) 
A  little  tincture  of  iodine  diluted  to  half  the  usual 
strength3  (which  is  7  per  cent.)  painted  over  the 
wound  and  surrounding  skin  is  an  excellent  means 
of  inhibiting  infection  for,  unlike  most  disinfec- 
tants, it  penetrates  the  skin.  It  will  make  the 
wound  sting  for  a  few  minutes  but  this  disagree- 
able sensation  soon  passes.  As  moisture  on  the 
skin  interferes  with  absorption,  the  iodine  should 
be  applied  before  the  skin  is  washed,  if  washing  is 
necessary.  (3)  If  the  skin  around  the  wound  is 
dirty  it  should  be  washed  with  boiled  water  and, 

1  Of  course  caution  must  be  observed  if  the  blood  is  coming  in 
spurts,  as  this  would  indicate  arterial  hemorrhage,  or  if  the  bleed- 
ing is  excessive. 

1  Holding  the  bleeding  part  lower  than  the  heart  encourages 
bleeding  and  raising  it  above  the  heart  is  an  important  step  in 
checking  bleeding. 

J  See  footnote  page  3. 


Wounds  295 

if  possible,  green  soap  before  a  permanent  dressing 
is  applied.  (4)  Everything  that  is  to  come  in 
contact  with  the  wound  itself  or  with  anything 
that  will  touch  such  articles  must  be  made  sterile 
and  kept  sterile. l 

Infected  wounds:  Nothing  will  be  said  here 
regarding  the  treatment  of  infected  wounds,  for 
this  is  too  important  to  be  left  to  home  care,  but 
some  knowledge  of  the  processes  that  occur  in 
infection  will,  I  am  sure,  be  found  interesting. 

Infection  of  wounds  implies,  as  previously 
stated,  the  entrance  of  bacteria  into  a  wound  in 
sufficient  numbers  to  produce  abnormal  conditions. 
Only  certain  species  of  bacteria,  chiefly  those 
classed  as  pyogenic  (pus-producing)  have  any  effect 
in  wounds,  but  some  species  which  enter  the  body 
through  wounds,  will  have  very  serious  systemic  ef- 
fects ;  of  this  class  are  the  organisms  causing  tetanus 
(lockjaw)  and  hydrophobia.2  It  is  usually  with 
the  pyogenic  types  of  bacteria  that  wounds  become 
infected.  There  are  several  varieties  of  these 
bacteria,  some  of  which  are  much  more  virulent 
than  others,  but  they  all  induce  the  following  con- 

1  It  is  to  be  understood  that  this  description  is  merely  for  a 
superficial  wound  in  which  there  is  no  foreign  matter.  If  any  of 
the  conditions  mentioned  as  needing  a  doctor's  inspection  exist,  a 
sterile  dressing  (see  page  301)  should  be  applied  and  the  doctor 
seen  at  once.  If  iodine  can  be  obtained  without  loss  of  time,  it  is 
well  to  paint  the  skin  around  the  wound  before  putting  on  the 
dressing. 

J  The  organism  causing  hydrophobia  is  injected  into  the  body 
by  the  bite  of  an  animal  usually  a  dog  that  has  the  disease. 


296  Nursing  Methods 

ditions,  the  more  toxic  species  doing  so  more 
rapidly  and  intensely  than  others.  As  the  result 
of  their  life  and  growth,  they  induce  local  irritation 
and  consequently  cause  the  dilation  of  the  blood- 
vessels in  the  part.  This  results  in  the  collection  of 
an  unusual  amount  of  blood  and  the  exudation  of 
an  extra  amount  of  fluid  from  the  vessels  into  the 
tissues.  Thus  the  part  becomes  red,  hot,  swollen, 
and  painful.  A  mild  stage  of  this  condition  is 
known  as  congestion  and  an  intense  stage  as  inflam- 
mation, and  the  symptoms  of  inflammation  are  said 
to  be  redness,  heat,  swelling,  pain,  and  imperfect 
functioning.  Under  such  conditions  large  numbers 
of  the  white  corpuscles  of  the  blood,  known  as 
phagocytes,  force  their  way  through  the  walls  of 
the  vessels  and  proceed  to  demolish  the  bacteria 
and,  if  they  succeed,  normal  conditions  in  the  part 
are  restored.  This  is  known  as  resolution.  On 
the  other  hand,  if  the  phagocytes  cannot  destroy 
the  bacteria  they  themselves  are  destroyed  in 
large  numbers,  and  also  cells  in  the  tissue  of  the 
wound  and  then  what  is  known  as  pus  is  formed. 
The  process  of  the  formation  of  pus  is  termed  sup- 
puration. Pus  consists  of:  Disintegrated  tissue, 
the  material  which  exudes  from  the  blood-vessels 
as  the  result  of  their  congestion,  living  and  dead 
bacteria  and  their  toxins,  the  phagocytes  that  have 
been  destroyed  by  the  bacteria. 

When  suppuration  occurs  an  incision  must  be 
made  in  the  tissue  (by  a  surgeon)  to  allow  the  pus 
to  escape,  otherwise  the  toxins,  and  even  the  bac- 


Wounds  297 

teria,  may  be  absorbed  and  a  very  serious  condition 
known  as  septicemia  (blood-poisoning)  result.  Also 
the  tissue  may  become  so  disintegrated  by  the 
suppurative  process  that  pus-filled  cavities,  known 
as  abscesses,  will  form. 

The  presence  of  bacterial  toxins  in  the  body, 
both  before  and  after  suppuration,  stimulates  the 
formation  of  new  phagocytes.  If  a  person  is  in  a 
healthy  condition  the  new  cells  develop  more 
rapidly  then  otherwise,  therefore,  in  the  treatment 
of  infections  everything  must  be  done  to  maintain 
the  patient's  health.  Another  important  item  in 
the  treatment  is  to  keep  the  infected  part  quiet, 
for  the  movement  of  the  muscles  in  the  area  hastens 
the  absorption  of  septic  material  and  furthers  its 
spread  through  the  surrounding  tissues. 

Though  not  connected  with  the  care  of  wounds, 
a  few  words  will  be  said  here  regarding  what  are 
sometimes  called  focal  infections:  Especially  in 
certain  parts  of  the  body,  such  as  the  sockets  or 
alveoli  of  the  teeth,  and  the  cavities  in  the  bones 
of  the  forehead,  and  cheeks  and  those  behind  the 
nose,  and  the  tonsils  when  they  are  not  normal, 
bacteria  may  enter  and  live  for  long  periods  and 
their  presence,  at  least  in  the  bone  cavities,  may 
not  be  recognized  because,  as  there  are  few  nerves 
in  these  parts,  pain  will  not  be  induced  and,  as 
there  are  few  blood-vessels,  the  absorption  of  toxic 
matter  goes  on  so  slowly  that  the  progress  of  the 
conditions  it  produces  may  be  very  insidious,  but 
many  diseases  of  the  joints  (usually,  though  often 


298  Nursing  Meshods 

erroneously,  called  rheumatism),  and  infections  of 
the  heart,  and  other  diseases  have  been  traced  to 
this  source.  Infections  in  the  tonsils  are  more 
easily  discovered  because  tonsillitis  generally 
occurs. 

Demonstration  27 
Dressing  a  Simple  Wound 

Important  precautions  to  remember  when  dress- 
ing a  wound:  (i)  Watch  that  nothing  unsterile 
gets  near  the  wound  or  near  anything  that  will 
come  in  contact  with  the  wound.  (2)  When  you 
are  not  using  the  scissors  and  forceps  keep  them 
in  the  dish  in  which  you  sterilize  them.  (3) 
Handle  the  gauze  and  cotton  with  the  scissors  and 
forceps,  never  with  your  fingers,  for  it  is  impossible 
to  make  these  sterile.  (4)  Either  wipe  the  rim  of 
a  bottle  before  pouring  out  a  liquid  or,  if  the  latter 
is  not  expensive,  discard  the  first  portion  that  flows 
over  the  rim.  (5)  Remember  the  instructions, 
given  later,  regarding  the  direction  in  which  the 
skin  is  to  be  rubbed  when  washing  around  a  wound. 
(6)  If  sterile  gauze  and  cotton  are  not  at  hand 
substitute  clean,  soft,  white  muslin,  and  make  it 
sterile  by  ironing  it  or  if  there  is  no  iron,  boiling  it. 
Prepare  one  piece  to  act  as  a  protector  for  those  to 
be  used  for  the  wound. 

Procedure :  Let  one  of  the  pupils  pretend  to  be 
the  wounded  person  and  sit  near  the  table  on  which 


Wounds  299 

the  supplies  are  to  be  placed,  and  let  another  pro- 
ceed as  follows :  cover  the  point  of  the  orange  stick 
with  soap  and  rub  it  under  your  nails;  scrub  your 
hands  thoroughly  with  soap  and  hot  water,  soak 
them  in  the  hot  water,1  rinse  them  in  cold  water.2 

In  the  instrument  dish,  boil  enough  water  to 
keep  the  instruments  covered  while  they  are  being 
sterilized ;  add  about  a  quarter  teaspoon  of  washing 
soda  for  each  cupful  of  water3;  put  a  small  wad  of 
clean  muslin4  into  the  dish;  open  the  scissors  and 
put  them  and  the  forceps  with  their  points  on  the 
muslin  pad.  Let  them  boil  for  three  minutes,  not 
more,  because  boiling  blunts  the  scissors. 

If  the  skin  around  the  wound  is  dirty  and,  for 
class,  it  had  better  be  pretended  that  it  is,  also  boil 
the  small  bowl,  a  piece  of  clean  muslin,  a  nail  brush, 
and  some  water. 

While  the  instruments  are  being  sterilized, 
spread  a  clean  towel  over  the  table  with  the  sur- 
face that  was  folded  inside  uppermost.  Remove 
the  outer  covers  from  the  cotton  and  gauze,  loosen 
but  do  not  remove,  their  inner  wrappers,  place 
them  on  the  towel.  Also,  get  out  the  adhesive 

1  This  is  to  increase  the  activity  of  the  sweat  glands  in  the  skin 
so  that  the  perspiration  will  wash  out  bacteria  from  the  ducts 
leading  from  the  glands  to  the  skin. 

3  This  is  to  check  secretion  and  contract  the  muscle  in  the  skin 
so  that  any  remaining  bacteria  will  not  be  washed  to  the  surface 
for  the  time  being. 

J  This  helps  to  disinfect  the  instruments  and  also  prevents 
them  from  rusting. 

4  This  is  to  protect  the  points  which  are  easily  blunted. 


300  Nursing  Methods 

plaster,  a  bandage,  ointment,  if  it  will  be  required 
(i.e.,  if  there  is  so  much  abrasion  of  the  skin  that 
the  dressing  would  be  likely  to  stick  to  the  wound) 
iodine  and,  if  the  skin  is  dirty,  either  green  soap,1 
lysol,  or  alcohol. 

As  soon  as  the  instruments  are  sterile  pour  the 
water  from  the  dish,  holding  the  latter  so  that  their 
blunt  ends  (and  not  the  points)  will  touch  the  sides 
of  the  dish  if  they  move  while  you  are  doing  so. 

Insert  the  points  of  the  forceps  under  the  cover 
on  the  cotton  (do  not  let  them  touch  the  outside), 
open  it  enough  to  allow  you  to  cut  off  a  small  swab 
(about  half  inch  square).  Dip  this  in  the  iodine 
(remove  and  replace  the  cork  in  the  bottle  as  de- 
scribed on  page  145) ;  pass  the  swab  over  the  wound 
and  surrounding  area. 

If  the  skin  is  very  dirty,  take  the  small  basin 
from  the  boiling  water  (you  can  use  the  forceps 
for  doing  so),  fill  it  with  water  and  enough  green 
soap2  to  make  a  lather,  or  else  put  some  alco- 
hol into  the  bowl.  For  the  treatment  of  a  real 
wound  about  fifteen  minutes  must  be  allowed  to 
elapse  before  the  skin  is  washed  and  the  water  can 
be  cooling  sufficiently  in  the  meantime,  however, 
it  should  be  used  as  hot  as  possible.  If  practicable, 
soak  the  part  in  the  lather,  if  not  soak  some  boiled 
muslin  or  sterile  gauze  in  the  lather  and  cover  the 

1  Other  soap  can  be  substituted,  but  this  is  better  for  surgical 
purposes. 

3  Other  soaps  can  be  substituted,  but  these  are  better  for  surgi- 
cal purposes  for  they  are  likely  to  be  purer  and  they,  especially 
the  lysol,  are  excellent  disinfectants. 


Wounds  301 

part  with  this.  When  the  skin  and  dirt  are  thus 
softened  take  the  forceps  and  scissors  and,  as  pre- 
viously directed,  cut  a  swab  of  cotton  or  gauze 
about  two  inches  square  and  wash  the  skin  sur- 
rounding the  wound;  when  doing  so,  rub  in  the 
direction  of  the  axis  of  the  wound,  do  not  rub  away 
from  the  wound,  because  this  draws  the  edges 
apart,  and  do  not  rub  toward  it,  because  this  may 
wash  foreign  matter  into  it.  If  necessary,  the  skin 
at  a  distance  from  the  wound  can  be  scrubbed  with 
the  nail  brush  or  boiled  muslin.  Pour  the  clear 
boiled  water  over  the  part  and  then  dry  it  by  gently 
patting  it  with  a  fresh  swab  of  cotton  or  of  sterile 
gauze. 

The  dressing,  unless  there  is  much  abrasion  of 
the  skin,  usually  consists  solely  of  gauze.  Cut  a 
piece  the  size  required  and,  touching  it  only  with 
the  forceps  and  scissors,  open  out  the  folds  and  then 
place  it  in  a  loose  mass  over  the  wound.1  Use  a 
strip  of  adhesive  plaster  to  hold  it  in  place  if  the 
bandage  is  not  likely  to  make  it  sufficiently  secure. 
Put  on  the  bandage. 

If  the  skin  is  abraided  it  will  be  better  to  use 
something  to  keep  the  gauze  from  sticking  to  the 
wound.  In  hospitals,  paraffin  preparations,  that 
are  sprayed  over  the  "wound  and  become  solid  when 
they  dry,  are  much  used  for  this  purpose,  for  they  do 
not  stick  to  the  wound  and  can  be  readily  lifted  from  it 
when  the  dressing  is  changed,  also  caps  made  of  wire 

1  When  the  gauze  is  arranged  in  this  way  it  absorbs  moisture 
from  the  wound  better  than  when  it  is  folded. 


302  Nursing  Methods 

and  sterilized  are  used,  the  cap  being  secured  over  the 
wound  and  the  dressing  put  on  over  it,  but  such  things 
are  not  likely  to  be  at  hand  in  homes  and  sterilized 
zinc  oxid,  purchased  in  a  tube,  is  probably  about 
as  good  as  anything  that  can  be  kept  for  emer- 
gencies. Do  not  use  the  portion  of  ointment  that 
comes  first  from  the  tube,  remove  it  with  the  for- 
ceps or  a  piece  of  sterile  cotton,  and  do  not  let  the 
tip  of  the  tube  touch  the  portion  of  gauze  that  will 
come  next  the  wound.  Leave  the  gauze  folded 
when  ointment  is  used  and  let  what  will  be  the 
outer  surface  of  the  gauze,  when  it  is  over  the 
wound,  rest  on  the  clean  towel  while  you  are  spread- 
ing the  ointment.  The  scissors  can  be  used  for  the 
spreading  if  there  is  no  sterile  spatula  at  hand  for 
the  purpose. 

Procedure  when  changing  a  dressing  on  a 
wound :  Prepare  as  for  a  first  dressing,  minus  the 
iodine  and  cleansing  outfit,  but,  if  the  dressing  has 
stuck  to  the  wound,  provide  some  warm  boiled 
water  and,  if  adhesive  plaster  was  used,  alcohol,  if 
possible,  though  the  warm  water  will  answer. 

Moisten  the  adhesive  plaster  where  it  is  attached 
to  the  skin,  preferably  with  alcohol,  then  pull  each 
side  in  turn,  quickly,  toward  the  wound.  The  re- 
moval of  the  adhesive  does  not  hurt  as  much  when  the 
strips  are  pulled  quickly  as  when  they  are  dragged  off 
slowly.  If  the  dressing  has  stuck  moisten  it  with 
sufficient  boiled  water  to  allow  of  its  easy  removal, 
but  use  as  little  water  as  possible  and  none  unless 
necessary.  Wash  away  any  dried  blood  from  the 


Wounds  303 

skin,  preferably  with  alcohol,  but  boiled  warm 
water  can  be  used.  Do  not  touch  the  wound  unless 
you  have  been  given  special  direction  from  a  doctor; 
the  less  a  wound  is  touched  or  moistened  the  better. 
Put  on  a  fresh  dressing. 


CHAPTER  XIV 

Fractures.     Dislocations.     Sprains. 
Hemorrhage. 

Nature  of  fractures.  How  bone  is  repaired.  Symptoms  and 
first  aid  treatment  of  fractures.  Nature,  symptoms,  and  treat- 
ment of  dislocations  and  sprains.  Nature  and  symptoms  of 
hemorrhage.  Natural  resources  of  the  body  for  arresting  hemor- 
rhage. First  aid  treatment  of  hemorrhage.  Demonstration  28: 
First  aid  treatment  of  fractures  and  hemorrhage. 

Equipment  for  demonstration:  Slings. 

Bandages. 

Splints  and  substitutes  such  as  a  cane,  umbrella, 
pieces  of  wood,  thick  cardboard. 

Charts  showing  the  skeleton  and  the  circulation. 

Material  for  improvising  tourniquets  such  as 
handkerchiefs,  pieces  of  muslin,  and  stones,  and 
sticks. 

Fractures 

A  fracture  is  what  is  commonly  known  as  a 
broken  bone.  A  fracture  usually  results  from 
either  a  blow  or  fall. 

In  old  age  the  bones  break  much  more  easily 

than  in  youth,  and  in  infancy  they  are  more  likely 
to  bend  than  to  break,  or  a  bone  may  become  bent 

304 


Fractures  305 

and  split  on  one  side,  a  condition  known  as  a 
greenstick  fracture,  because  it  resembles  the  manner 
in  which  newly  formed  green  twigs  of  trees  act 
when  endeavor  is  made  to  break  them. 

The  reason  for  this  difference  in  fractures  is  that 
at  birth  the  bones  contain  very  little  mineral 
matter  and  resemble  what  is  known  as  cartilage, 
a  tough,  but  somewhat  elastic  substance  that  will 
bend  and  stretch  to  some  extent,  but  does  not 
break  in  the  same  manner  as  bone.  From  the  day 
of  birth,  however,  there  is  a  gradual  deposition  of 
mineral  matter  (obtained  from  food)  in  the  bones 
so  that  all  through  life  they  are  becoming  harder 
but,  as  age  advances,  brittle. 

Sometimes,  when  a  bone  is  broken,  a  wound  is 
also  made  in  the  soft  tissues  above  the  bone  so 
that  the  latter  is  exposed  to  the  open  air.  This 
constitutes  what  is  known  as  a  compound  fracture, 
and  it  is  a  much  more  serious  condition  than  a 
simple  fracture,  as  a  break  is  called  when  it  is  not 
complicated  with  other  injuries.  For  one  reason, 
infection  is  very  likely  to  occur  and  then  the  union 
of  the  severed  bones  will  be  delayed  and  possibly 
prevented. 

Bones  heal  because  new  cells,  derived  from  those 
around  the  edges  of  the  severed  portions  of  bone, 
come  into  being  and  they,  together  with  material 
which  they  excrete,  and  substances  that  exude  from 
the  blood-vessels,  soon  form  a  tough,  fibrous  mater- 
ial, known  as  callus  that  holds  the  severed  ends 
together.  Gradually,  mineral  matter,  chiefly  cal- 


306  Nursing  Methods 

cium  (lime)  phosphate,  is  deposited  in  the  callus, 
and  hardens  it  so  that,  in  about  ten  days  from  the 
date  of  fracture  it  will  be  fairly  firm  and,  at  the 
end  of  two  months,  if  the  person  is  healthy  and 
there  are  no  complications,  the  bone  will  probably 
be  as  hard  as  before  it  was  broken. 

The  special  symptoms  of  fracture  are  what  is 
known  as  crepitus,  which  is  the  sound  heard  when 
the  ends  of  the  broken  bone  move  against  each 
other  and  there  is  likely  to  be  a  false  point  of 
motion,  that  is,  the  bone  moves  at  the  point  of 
fracture.  Also,  there  will  be  pain,  redness,  and 
swelling  (due  to  the  increased  amount  of  blood  that 
flows  to  the  part  as  the  result  of  the  irritation)  and, 
sometimes,  a  purplish  discoloration  (due  to  the 
extravasation  of  blood  into  the  tissues  from  rup- 
tured capillaries).  Though  the  two  symptoms 
first  mentioned  are  the  only  ones  not  present  in 
other  injuries  and,  unless  an  X-ray  picture  is  taken, 
the  only  positive  signs  of  fracture,  no  attempt  is  to 
be  made  to  discover  them  by  anyone  but  a  physi- 
cian or  surgeon  for  incompetent  manipulation  of 
severed  bones  may  cause  serious  injury  to  the  sur- 
rounding tissue.  To  avoid  any  chance  of  trouble, 
if  the  visible  symptoms  are  pronounced,  the  part 
should  be  treated  as  though  the  bone  were  broken. 

Treatment:  Even  if  a  surgeon  cannot  get  to  the 
patient  for  two  or  three  days,  an  incompetent 
person  should  not  attempt  to  reduce  a  fracture,1 

1  The  words  reduce  and  set  are  used  for  the  restoration  of  the 
pieces  of  the  severed  bone  to  their  normal  position. 


Fractures 


307 


but  should  take  means  to  keep  the  injured  part 
perfectly  quiet  in  a  firm,  flat  surface  and,  if  possible 
covered  with  an  ice-cap  or  iced  compresses  (the 
cold  tends  to  keep  the  local  blood-vessels  con- 
tracted and  thereby  to  lessen  congestion  and 
swelling),  and,  if  the  injured  part 
is  a  limb,  bandaged  to  something 
that  will  act  as  a  splint.  The 
reason  for  the  splint  is  that, 
even  if  the  patient  does  not  move 
voluntarily,  the  nerve  impulses 
induced  by  the  irritation  cause 
muscular  contractions  that  are 
likely  to  drag  the  portion  of 
the  severed  portions  of  bone 
out  of  place,  as  shown  in  Fig.  78, 
and  it  will  then  be  more  difficult 
for  the  surgeon  to  set1  the  frac- 
ture properly.  A  straight  piece 
of  board  makes  the  best  tem- 
porary splint,  and  it  will  give  the 
greatest  degree  of  support  if  it 
is  attached  to  the  under  surface  **  ?8' 

displacement  of  bones 

of  a  limb,   especially  if  this  is  in  a  fracture. 
a  leg,  but  the  limb  should  be 
moved  as  little  as  possible  when  the  splint  is  passed 
under  it  and,  if  necessary  to  raise  it,  someone 
should  hold  it  above  and  below  the  point  of  frac- 
ture so  as  to  prevent  movement  of  the  severed  bone. 
If  possible  the  splint  should  be  covered  with  some- 
1  See  note  on  p.  306. 


308  Nursing  Methods 

thing  soft  and,  it  is  even  more  important,  after  it 
is  in  place,  to  fill  hollow  spaces,  as  under  the  knee 
and  ankle  with  something  soft,  even  grass  or  moss 
can  be  used.  If  a  board  cannot  be  obtained  any- 
thing firm  can  be  substituted,  for  example,  several 
layers  of  cardboard,  or  even  a  stick,  cane,  umbrella, 
branches  of  trees  can  be  used,  and,  if  nothing  suit- 
able can  be  found,  an  injured  leg  can  be  strapped 


Fig.  79.    An  emergency  splint  for  the  kg. 

to  the  uninjured  one  and  a  broken  arm  to  the  chest 
or  the  arm  can  be  held  in  a  sling  and  a  stick  at- 
tached as  shown  in  Fig.  79  or  if  it  is  the  forearm 
that  is  injured  the  stick  should  be  attached  to  it. 

Dislocations 

A  dislocation  is  an  injury  in  which  one  of  the 
bones  of  a  joint  is  out  of  its  socket.  It  is  associated 
with  stretching  and  tearing  of  the  ligaments  (the 
bands  of  fibrous  tissue  that  hold  bones  together 
at  the  joints) .  A  dislocation  may  be  caused  by  a 
fall,  or  blow,  or  strain  due  to  a  forcible  movement. 


Dislocations 


309 


The  joints  most  subject  to  dislocation  are  the 
shoulders,  hip  joints,  lower  jaw,  thumb,  and 
fingers. 

The  symptoms  are :  Deformity  (due  to  the  mis- 
placed bone),  severe  pain,  inability  to  move  the 


Fig.  80.     Temporary  splint  for  the  arm. 

joint  properly,  and  there  is  usually  swelling,  and 
discoloration  of  the  surrounding  parts. 

Treatment:  The  jaw  and  fingers  are  usually 
easily  put  into  place  and  therefore  if  a  surgeon 
cannot  be  found  within  a  short  time  it  is  permis- 
sible to  perform  the  operation,  especially  to  get  the 
jaw  into  place,  for,  when  this  joint  is  dislocated, 
the  mouth  cannot  be  closed  and  the  pain  is  ex- 
treme. No  attempt,  however,  should  be  made  to 


310  Nursing  Methods 

put  a  large  joint  into  place,  even  if  it  is  necessary 
to  wait  a  day  or  two  for  a  surgeon,  for  incompetent 
manipulation  is  likely  to  result  in  severe  injury  to 
the  tissues  which  will  make  it  more  difficult  for 
the  surgeon  to  get  good  results  and  may  cause  per- 
manent deformity  and  lack  of  mobility.  There- 
fore, the  first  aid  treatment  is  the  same  as  for  that 
of  fractures,  namely,  to  immobilize  the  part  with  a 
splint,  sling,  or  bandage  as  required  and  apply  cold. 
To  reduce  a  dislocation  of  the  jaw:  Have  the 
patient  sit  upright  with  a  firm  support  at  the  back 

of  her  head;  put  a 
compress  or  several 
layers  of  bandage  or 
other  protector 
around  your  thumbs, 
place  them,  one  on 
each  side,  on  the 
patient's  back  teeth, 

Fig.  81.     Method  of  reducing  a  dis-  _ 

located  jaw.  Put  yourfingers  under 

and  behind  the  jaw, 

as  shown  in  Fig.  81,  and  then  press  downward  and 
backward  while,  at  the  same  time,  you  push  the 
chin  upward.  Be  prepared  to  remove  your  thumbs 
the  instant  the  jaw  moves,  because  it  is  likely  to 
snap  into  place  suddenly,  it  is  for  this  reason  that 
the  thumbs  are  protected.  When  the  jaw  is  in 
place  support  it  with  a  bandage  such  as  shown  in 

Fig.  74- 
To  reduce  a  dislocation  of  the  fingers  or  thumb, 

if  a  doctor  cannot  be  found,  make  gentle  traction 


Sprains  31 l 

(pulling)  on  the  finger  or  thumb  and  at  the  same 
time  with  the  other  hand  move  the  bone  into  its 
proper  position. 

Sprains 

A  sprain  is  an  injury  to  a  joint  consisting  of 
more  or  less  twisting  or  wrenching  and,  sometimes, 
tearing  of  the  tendons  (the  fibrous  cords  which  hold 
muscles  to  bones)  and  ligaments  (the  fibrous  bands 
which  hold  the  bones  of  a  joint  together),  but, 
unless  the  sprain  is  complicated  by  a  fracture  or  a 
dislocation,  there  is  no  break  or  displacement  of  a 
bone. 

Sprains  are  caused  by  unnatural  movements  of 
a  joint  and  occur  most  frequently  in  the  ankle. 

The  symptoms  are  severe  pain  which  is  increased 
by  motion,  swelling,  and  more  or  less  discoloration 
of  the  part  and  interference  with  movement.  It 
will  be  noticed  that  the  only  symptoms  of  a  frac- 
ture that  are  lacking  are  those  for  which  only  a 
surgeon  should  seek  or  even  be  likely  to  recognize. 
Therefore,  if  there  is  much  pain  or  swelling  in  the 
injured  part,  treat  it  as  if  the  bone  were  fractured 
until  it  is  seen  by  a  surgeon. 

The  first  aid  treatment  for  sprains  consists  in 
keeping  the  part  quiet  and  elevated  (i.e.,  with  one 
or  two  pillows  under  it)  and  covered  with  either 
cold  or  hot  applications  until  the  pain  subsides,  it 
is  then  bandaged.  Moderate  exercise  is  usually 
allowed.  If  the  sprain  is  a  severe  one  the  surgeon 


312  Nursing  Methods 

is  likely  to  prescribe  massage  and  to  apply  adhesive 
strapping  before  the  part  is  bandaged. 

Hemorrhage 

The  term  hemorrhage  signifies  profuse  bleeding. 
According  to  the  nature  of  the  vessel  from  which 
the  blood  escapes  hemorrhage  is  known  as  arterial, 
venous,  or  capillary. 

There  are  certain  differences  in  these  three 
forms  of  hemorrhage,  namely :  When  the  bleeding 
is  from  an  artery,  the  blood  is  a  very  bright  red 
and  it  is  expelled  in  spurts,  which  correspond  to  the 
contractions  of  the  heart,  and  enough  blood  may 
be  lost  from  large  arteries  such  as  the  femoral  (in 
the  thigh)  and  the  brachial  (in  the  arm)  see  Fig. 
82,  in  about  five  or  ten  minutes  to  cause  death. 
Blood  from  the  veins  is  darker  than  that  from  the 
arteries,  because  it  contains  less  oxygen,  and  it 
flows  more  slowly  and  in  a  steady  stream,  because, 
as  the  small  capillaries  are  between  the  arteries 
and  the  veins,  the  flow  of  blood  in  the  veins  is  not 
as  directly  influenced  by  the  contractions  of  the 
heart  as  it  is  in  the  arteries.  In  capillary  hemor- 
rhage the  blood  oozes  slowly  from  the  surface  of  the 
wound  or  into  the  tissues.  The  discoloration  seen 
in  bruises  is  the  result  of  capillary  hemorrhage 
under  the  skin. 

Symptoms  of  hemorrhage:  Hemorrhage  from 
small  vessels,  even  arteries  and  veins,  will  usually 
be  controlled  or  even  cease  without  treatment 


Hemorrhage  313 

before  enough  blood  is  lost  to  induce  systemic 
symptoms,  but  if  sufficient  blood  is  lost  to  deprive 
the  tissues  of  their  necessary  oxygen  and  fluid  and 
to  interfere  with  the  action  of  the  heart  the  follow- 
ing symptoms  appear:  Pallor  of  the  skin;  weak, 
sighing  breathing;  thirst;  restlessness;  a  longing 
for  fresh  air ;  dizziness ;  rapid,  weak,  irregular  pulse ; 
fall  of  temperature.  As  a  rule,  there  is  also  the 
flow  of  blood  from  the  wound,  but,  occasionally, 
even  a  large  vessel  may  be  severed  without  the 
production  of  an  external  wound. 

The  body  is  provided  with  certain  natural  re- 
sources that  are  of  great  help  in  controlling  hemor- 
rhage, namely :  (i)  The  elastic  nature  of  the  blood- 
vessels which,  when  vessels  are  severed,  causes 
them  to  contract  and  thereby  reduces  the  size  of 
the  openings;  (2)  the  blood  tends  to  coagulate  as 
soon  as  it  comes  in  contact  with  air,  or  the  tissues, 
or  other  foreign  substance,  such  as  the  dressing 
of  a  wound,  and  the  clots  block  the  openings;  (3) 
the  heart  action  is  weakened  as  soon  as  there  has 
been  any  considerable  loss  of  blood  and  less  blood 
is  then  sent  through  the  vessels. 

The  principal  points  to  be  observed  in  the  first 
aid  treatment  of  hemorrhage  are:  (i)  Keep  the 
patient  quiet  and  reassure  her,  for  movement,  fear, 
or  excitement  will  increase  the  rate  of  the  heart 
action ;  (2)  raise  the  bleeding  part  higher  than  the 
heart,  because,  as  the  blood  must  then  flow  to  it 
against  gravity,  the  force  of  the  circulation  in  the 
wounded  vessels  is  reduced ;  (3)  if  the  hemorrhage 


Nursing  Methods 

is  from  a  vessel  in  the  leg  below  the  knee  or  in  the 
forearm,  in  addition  to  raising  the  limb,  flex  it  at 
the  joint  (knee  or  elbow)  for  this  interferes  with  the 
flow  of  blood  in  the  large  vessels  passing  through 
the  joints  and  it  is  through  these  that  the  vessels 
in  the  lower  part  of  the  limbs  receive  their  blood ; 
(4)  expose  the  wound  to  the  air,  which  favors 
clotting  of  the  blood;  (5)  make  pressure  either  on 
the  bleeding  vessels  or  on  the  large  vessels  of  which 
they  are  branches,  at  the  points  indicated  in  Fig. 
82.  If  the  blood  is  coming  from  an  artery  make 
pressure  between  the  wound  and  the  heart ;  if  the 
hemorrhage  is  from  a  vein  it  may  be  also  necessary 
to  make  pressure  between  the  wound  and  the  peri- 
phery, *  to  prevent  the  escape  of  the  blood  that  is 
already  in  the  veins. 

Pressure  upon  the  bleeding  vessels  is  spoken  of 
as  direct  pressure;  that  upon  the  main  vessels  as 
indirect  pressure. 

Whenever  possible,  direct  pressure  is  made, 
because  hemorrhage  is  most  easily  controlled  in 
this  way.  To  make  it,  put  on  a  sterile  glove  or 
encase  your  finger  in  a  sterile  compress  and,  putting 
it  into  the  wound,  press  firmly  against  the  bleeding 
vessels.  Hold  it  thus  until  a  surgeon  comes  or  the 
bleeding  ceases.  In  the  latter  case  bandage  tightly 
folded  compresses  into  and  over  the  wound.  If 
the  bleeding  was  at  all  severe,  do  not  leave  the 
patient  until  the  surgeon  has  tied  the  severed 
vessels,  for  the  slightest  movement,  even  excite- 

1  The  end  farthest  from  the  heart. 


Facial 


Innominate 


.External  Carotid 
,Common  Carotid 
,'Subc/av/a.n 
..--Aorta 
.-••Axillary 

.'Brachiat 


,Ulnar 


Radial 


£xterna/  iliac 
Internal  iliac-''' 


1 — Anterior  tibia/ 

foster /or  tibia/ 
— Dorsa/is  f>edis 


Fig.  tS'j.     Diagram  showing  plan  of  distribution  of  arteries  and  veins.      '1  he 
arrows  indicate  the  points  where  pressure  may  best  be  applied. 


Hemorrhage 


315 


Fig.  83.  Improved  tourniquet 
made  with  a  handkerchief,  stick, 
and  stone. 


ment,  may  dislodge  the  clot  that  arrested  the 
hemorrhage  and  the  bleeding  recommence.  As 
stated  in  the  section 
describing  the  treat- 
ment of  wounds,  clean, 
soft  muslin  pressed 
with  a  hot  iron  can  be 
used  as  a  substitute  for 
the  ordinary  surgical 
compresses  used  for 
dressing  wounds. 

If  there  is  nothing 

sterile  at  hand,  indirect  pressure  must  be  made 
until  sterile  supplies  can  be  obtained.  Indirect 
pressure  may  be  made  with  the  fingers  (digital 
pressure)  or,  on  the  limbs,  with  a  tourniquet.  In 
emergency  a  handkerchief,  or  a  strip  of  muslin  or 

any  fairly  strong 
material  and  a 
stick  and  stone 
or  similar  objects 
can  be  utilized  for 
a  tourniquet. 

To  use  such  an 
improvised  tour- 
niquet put  the 
stone  in  the  center 


Method  of  making  digital  com- 
pression. 


Fig- 84. 

of    the    handker- 
chief and  this  over 

the  artery  supplying  the  bleeding  part,  tie  the 
material,  as  shown  in  Fig.  80,  place  the  stick  over 


316  Nursing  Methods 

the  knot,  tie  it  in  place,  and  then  twist  the  stick 
until  the  bleeding  ceases. 

The  places  on  which  to  make  pressure  with  the 
fingers  or  stone  are  shown  in  Fig.  82  and  the 
following  table: 

To  arrest  bleeding  from:  Make  pressure  on: 

The  scalp  The  temporal  arteries. 

The  face  The  facial  artery  on  the  side  of  the 

bleeding. 
The  neck  The  carotid  artery  on  the  side  of 

the  bleeding. 

The  shoulder  or  axilla  The  subclavian  artery. 

The  arm  The  brachial  artery. 

The  wrist  or  hand  Either  the  brachial  or  the  radial 

and  ulnar  arteries. 
The  thigh  The  femoral  at  either  of  the  points 

indicated  in  Fig.  82. 
The  leg  or  foot  Either  on  the  femoral  artery,  as 

for  the  thigh,   or  on  the  popliteal 

artery,  by  flexing  the  leg  on  a  pad  as 

shown  in   Fig.  85   or  on  the  tibial 

artery. 

A  very  important  point  to  remember  in  connec- 
tion with  indirect  pressure  is  that  it  cannot  be 
continued  for  more  than  an  hour  without  danger  of 
causing  gangrene  (death  of  the  tissue)  in  the  part 
that  is  deprived  of  blood.  Therefore,  it  is  most 
important  to  get  a  surgeon  and  sterile  supplies  as 
quickly  as  possible.  If  a  surgeon  does  not  arrive  at 
the  end  of  an  hour  the  pressure  must  be  released, 
very  slowly,  sufficiently  to  allow  the  blood  to  flow 
into  the  part;  if  bleeding  starts  again,  the  pressure 
must  be  resumed  after  a  few  minutes,  but  it  must 


Hemorrhage 


317 


be  released  for  at  least  a  minute  or  two  about  every 
half  hour  until  help  arrives.  As  soon  as  sterile 
supplies  are  ob- 
tained pack  the 
wound  and  apply 
a  tight  bandage, 
then,  with  the  part 
in  the  proper  posi- 
tion, as  described 
on  page  313,  re- 
lease the  pressure 
to  some  degree,  but 
very  slowly,  so  as 
not  to  risk  dislodg- 
ing clots  that  may 
have  formed  by  a 
rush  of  blood. 

Hemorrhage 
from  parts 
the  elbow  or  knee 

if  not  severe,  can  usually  be  easily  controlled  by 
placing  a  thick  wad,  of  soft,  but  tightly  rolled, 
material  in  the  bend  of  the  joint  as  shown  in  Figs. 
85  and  86  and  holding  the  arm  or  leg  in  position 
either  with  the  hand  or  a  bandage. 

Heat  and  cold  tend  to  check  hemorrhage,  heat 
because  it  hastens  the  coagulation  of  the  blood  and 
cold  because  it  induces  nerve  reflexes  that  con- 
tract the  blood-vessels.  Therefore  hot  irrigations 
are  often  used  to  check  hemorrhage  in  cavities 
and  cold  is  very  commonly  used  externally,  for 


Fig.  85.     Forced  flexion  of  the  knee  to 
below   arrest  hemorrhage  in  parts  below  it. 


318  Nursing  Methods 

example,  an  ice-cap  is  applied  over  the  stomach 
for  hemorrhage  in  that  organ.  A  very  important 
point  to  remember  regard- 
ing the  use  of  hot  irrigations 
is  that  they  must  be  as  hot 
as  can  be  employed  with- 
out burning,  which  is  about 
120°  F.,  for  moderate  tem- 
peratures tend  to  dilate  the 
blood-vessels  and  favor 
hemorrhage. 

A     number     of     drugs, 
classed    as    styptics,     are 
.  sometimes   used   to    check 

Ftg.  86.    Forced  flexion  of 

the  elbow  to  arrest  hemorrhage  hemorrhage,  which  they 
in  the  forearm  or  hand.  may  do  by  contracting 

the  blood-vessels.     One  of 

these  is  acetic  acid,  which  is  contained  in  vinegar, 
and  another  is  tannin,  a  constituent  of  tea  leaves, 
therefore,  either  hot  or  iced  vinegar  or  boiled  tea 
(for  which  four  or  five  times  the  usual  amount 
of  tea  leaves  are  used)  is  very  commonly  employed 
to  check  bleeding  from  cavities. 

For  hemorrhage  from  the  nose,  make  the  person 
keep  quiet  with  the  head  hanging  backward, 
never  forward,  put  something  cold,  as  a  piece  of  ice 
or  a  chilled  door  key  at  the  back  of  the  neck  and 
either  hold  the  nostrils  compressed  tightly,  or  put  a 
wad  of  paper  or  cloth  under  the  upper  lip.  If  this 
treatment  is  not  effectual  plug  the  nostril  from 
which  the  blood  is  coming  with  cotton  wet  with 


Hemorrhage  319 

either  hot  or  iced  vinegar  or  boiled  tea.  If  this  does 
not  control  the  hemorrhage,  get  advice  from  a 
doctor. 

For  hemorrhage  after  extraction  of  a  tooth, 
place  a  plug  of  tightly  wadded  gauze  or  suitable 
substitute  in  the  cavity  and  press  the  teeth  of  the 
other  jaw  upon  it,  if  the  hemorrhage  is  not  checked 
use  a  fresh  plug  moistened  with  vinegar  or  tea  or 
substitute  a  piece  of  ice  for  the  plug.  If  the  bleed- 
ing is  very  profuse  and  is  not  checked  by  these 
means  notify  the  dentist  or  a  doctor. 

For  hemorrhage  from  the  internal  organs  there 
is  very  little  that  a  person  not  experienced  in  the 
care  of  the  sick  can  do  except  send  for  the  doctor, 
keep  the  patient  quiet  and  in  a  position  unfavor- 
able for  the  flow  of  blood  to  the  part,  and,  if 
possible,  put  ice-caps  over  the  bleeding  organ,  and, 
if  the  hemorrhage  is  from  the  stomach  give  small 
pieces  of  ice  by  mouth,  they  must  be  swallowed  as 
ice  and  not  allowed  to  melt  in  the  mouth.  Ice  is 
also  often  given  when  the  hemorrhage  is  from  the 
lungs,  for,  probably  as  the  result  of  reflexes  in- 
duced by  the  cold  in  the  mouth,  it  sometimes  has 
a  beneficial  effect ;  at  any  rate  it  does  no  harm  'and 
it  helps  to  make  the  patient  feel  that  something  is 
being  done  for  her.  Blood  coming  from  the  lungs 
has  a  frothy  appearance  because  of  the  air  mixed 
with  it  and,  therefore,  hemorrhage  from  the  lungs 
is  easily  distinguished  from  that  coming  from  the 
stomach. 


320  Nursing  Methods 

Demonstration  28 
First  Aid  Treatment  in  Hemorrhage  and  Fractures 

Procedure:  The  pupils  should  first  study  the 
course  of  the  blood-vessels  on  the  charts  and  prac- 
tice stopping  the  pulse  by  digital  pressure,  this  is 
best  done  on  the  arm  as  follows:  Make  pressure 
with  the  fingers  of  one  hand  on  your  neighbor's 
brachial  artery  and  keep  the  fingers  of  your  other 
hand  on  the  radial  artery.  Make  sufficient  pres- 
sure to  arrest  the  pulse  in  the  radial  artery.  Cessa- 
tion of  pulsation  of  the  artery  shows  that  blood  is 
no  longer  flowing  into  it  and  thus,  where  there  is 
a  hemorrhage  below  the  point  of  pressure,  it  would 
be  arrested. 

After  all  the  pupils  have  tried  this  and  ascer- 
tained how  to  manipulate  an  improvised  tourni- 
quet let  some  of  the  pupils  act  as  subjects  and 
pretend  to  have,  either  a  hemorrhage  or  fracture, 
or  both,  and  let  others  treat  the  subjects  according 
to  the  direction  just  given,  acting  in  all  respects  as 
though  the  emergencies  were  real. 


CHAPTER  XV 
Fire.    Burns.    Scalds.    Frost-bite.    Chilblain 

How  to  put  out  fires.  How  to  escape  and  help  others  escape 
from  burning  buildings.  Demonstration  29:  Extinguishing 
flames  from  the  clothing  and  use  of  fire  extinguishers.  Various 
causes  and  treatments  of  burns.  Treatment  of  scalds.  Nature, 
causes,  and  treatment  of  frost-bite  and  chilblain.  Other  conse- 
quences of  exposure  to  cold. 

Equipment  for  demonstration :  Blankets  or  sub- 
stitutes and  if  possible,  different  varieties  of  fire 
extinguishers. 

Much  unnecessary  suffering,  loss  of  life,  and  de- 
struction of  property  is  constantly  occurring  be- 
cause people  do  not  do  the  right  things  when  a 
fire  starts.  To  realize  what  should  be  done  both 
to  put  out  fires  and  to  escape  from  fires  and  their 
consequences  the  following  facts  should  be  known : 

(i)  Burning  consists  in  the  union  of  oxygen  with 
matter  and,  therefore,  if  air  is  excluded  from  burn- 
ing material  the  fire  will  be  extinguished.  Air  can 
be  excluded  by  pressing  something  hard  or  thick, 
as  wood,  rugs,  blankets,  tightly  upon  the  burning 
material,  or  by  covering  the  latter  with  carbon 
dioxid,  which  is  heavier  than  air  and  therefore 
does  not  diffuse  readily.  This  is  what  is  done 
21  321 


322  Nursing  Methods 

when  the  majority  of  fire  extinguishers  are  used, 
for  these  contain  chemicals  that  interact  when 
poured  over  the  flames  and  liberate  carbon  dioxid. 

2 .  Movement  of  air,  such  as  is  created  by  a  draft 
or  a  person  running,  favors  the  spread  of  fire;  it 
will  also  hasten  the  diffusion  of  the  carbon  dioxid 
poured  over  a  flame. 

3.  Wet  material,  provided  the  moisture  is  not 
due  to  an  inflammable  substance,  as  ether  or  oils, 
has  a  much  higher  kindling  temperature  than  dry 
and  will  not  take  fire  readily. 

4.  Many  of  the  deaths  that  occur  when  people 
are  trapped  by  fire,  especially  in  crowded  buildings, 
are  due  to  asphyxia  caused  by  the  inhalation  of 
smoke.    As  smoke  is  lighter  than  air  it  rises,  there- 
fore, there  is  practically  no  smoke  within  about 
six  inches  of  the  floor. 

5.  Another  common  cause  of  death  following 
accidents  due  to  fire  is  shock,  and  death  from  this 
cause  has  often  occurred  when  there  has  been  rela- 
tively little  external  injury.     Probably  the  chief 
reason  for  this  is  that  the  intense  terror  experienced 
is  conducive  to  shock,  but  also  creates  excitement, 
which  retards  the  onset  of  the  conditions  con- 
stituting shock,  but  increases  their  intensity  later, 
especially  if  the  person  is  allowed  to  move  around, 
as  is  likely  to  be  the  case  when  the  internal  injuries 
are  not  extensive. 

Procedure  in  putting  out  a  fire :  If  anything  in 
the  room  catches  fire,  at  once  bang  something  hard 
upon  it  or  envelop  it  tightly  in  a  rug,  heavy  coat, 


Fire  323 

blanket,  or  the  like.  If  this  is  not  effectual  shut  the 
doors  and  windows  (to  prevent  a  draft) ;  send  some- 
one to  summon  the  fire  brigade  and,  if  possible, 
get  and  use  a  fire  extinguisher,  otherwise,  except 
when  the  flame  is  due  to  burning  oil,  get  water  and 
pour  it  over  the  flaming  material.  Water  should 
not  be  used  to  extinguish  burning  oil,  for  it  will 
not  do  so  and,  as  oil  floats  on  water,  it  will  spread 
the  flame.  Good  things  to  use  to  extinguish  burn- 
ing oil  are  the  fire  extinguisher,  clay,  sand,  ashes, 
or  wet  blankets  pressed  tightly  upon  the  burning 
mass. 

To  avoid  becoming  asphyxiated  when  sur- 
rounded with  smoke  tie  something,  wet  if  possible, 
over  your  nose  and  mouth  and,  if  there  is  much 
smoke,  crawl  to  safety  on  your  hands  and  knees, 
keeping  your  face  near  the  floor.  Try  to  make 
others  do  likewise  and  do  not  get  excited. 

If  your  clothes  catch  fire,  do  not  run  for  help, 
because  this  will  favor  the  spread  of  the  flames,  but, 
if  the  ignited  area  is  small,  immediately  make 
hard  pressure  against  it  with  something  hard,  as 
wood  or  the  wall,  if  this  is  not  at  once  effectual  lie 
down  on  the  floor  and  draw  the  rug  tightly  around 
you,  or,  if  there  is  no  rug,  anything  that  can  be 
used  as  a  substitute  (e.g.,  bedclothes,  or  a  heavy 
coat,  or  blanket)  and  if,  when  lying  still,  you  do 
not  press  on  a  sufficient  area  to  smother  all  the 
flames,  roll  slowly  on  the  floor  in  such  a  manner 
that  you  will  press  upon  all  the  burning  parts. 
It  is  most  important  to  lie  down  because,  as  the 


3-4  Nursing  Methods 

flames  and  smoke  rise,  the  fire  will  spread  over 
your  clothing  more  rapidly  when  you  are  in  the 
erect  position. 

If  anybody  else's  clothing  catches  fire  help  or 
force  her  to  carry  out  the  preceding  directions. 

When  enveloping  a  person  in  a  blanket,  etc.,  or 
when  drawing  one  around  yourself,  put  it  first 
between  the  flames  and  the  face,  otherwise,  you 
are  likely  to  fan  the  flame  toward  the  latter. 

Demonstration  29 
Extinguishing  Fire 

Procedure:  Some  of  the  pupils  should  pretend 
that  their  clothes  are  on  fire  and  others  put  the 
preceding  instruction  into  effect. 

Burns.     Scalds 

A  burn  is  generally  denned  as  a  lesion  of  tissue 
induced  by  heat,  but  similar  lesions,  also  commonly 
known  as  burns,  are  produced  by  other  agents 
such  as  the  X-rays,  the  chemical  rays  of  the  sun, 
various  chemical  substances  such  as  strong  acids 
and  alkalies  (especially  caustic  soda  and  potash 
and  lime)  and  irritating  substances  such  as  mus- 
tard and  iodine. 

Burns  are  usually  classified  according  to  the 
amount  of  tissue  destroyed  as  being  of  the  first, 
second,  or  third  degree.  A  burn  of  the  first  degree 


Burns.    Scklds  325 

is  one  in  which  the  skin  is  reddened,  because  of 
slight  congestion  in  its  blood-vessels,  but  is  not 
actually  injured.  A  burn  of  the  second  degree  is 
one  in  which  there  is  inflammation  of  the  skin  and 
blisters.  Blisters  are  due  to  the  exudation  of  fluid 
from  the  congested  blood-vessels  which  raises  the 
outer  layer  of  skin  from  the  underlying  tissue. 
Burns  of  the  third  degree  are  those  in  which  there 
is  charring  and  destruction  of  both  the  skin  and 
deeper  tissues. 

The  only  treatment  necessary  for  a  small  burn 
of  the  first  or  second  degree  is  to  cover  the  part 
with  something  clean  and  non-irritating  that  will 
exclude  the  air  and  will  not  adhere  to  the  skin. 
Examples  are:  A  compress  of  soft  muslin  covered 
on  one  side  with  an  emollient  such  as  boric  acid 
ointment,  or  zinc  oxid  ointment,  or  cold  cream,  or 
the  compress  may  be  saturated  with  a  bland  oil 
(such  as  olive  or  linseed  oil)  or  with  a  solution  of 
sodium  bicarbonate  (made  by  dissolving  about  a 
teaspoonful  of  baking  soda  in  a  cupful  of  water). 
When  the  solution  is  used  the  compress  must  be 
moistened  at  intervals  because  the  liquid  will 
evaporate  and  the  muslin  will  stick  to  the  wound. 

If  the  burn  is  at  all  extensive  send  for  the  doctor, 
if  only  because  of  the  danger  of  shock.  Do  not, 
however,  wait  his  arrival  to  cover  the  burned  area, 
because  the  destruction  of  skin  leaves  the  nerve 
endings  exposed  and,  until  they  are  covered  with 
something  that  will  prevent  their  stimulation,  the 
pain  is  likely  to  be  excruciating.  A  dressing  such 


326  Nursing  Methods 

as  any  of  those  mentioned  may  be  used  or  the 
burned  part  may  be  immersed  in  cold  water  or  a 
solution  of  sodium  bicarbonate  made  as  described 
in  the  preceding  paragraph.  When  dressing  a 
burn  use  small  compresses  so  that  when  the  dress- 
ing is  changed  a  large  area  need  not  be  exposed  at  a 
time  for  the  pain  is  thereby  increased. 

The  term  scald  is  applied  to  an  injury  due  to 
moist  heat.  The  nature  and  treatment  for  scalds 
are  similar  to  those  of  burns. 

The  treatment  for  burns  due  to  other  agents 
than  heat  is  the  same  as  for  the  latter  plus,  in  the 
case  of  those  due  to  a  chemical,  the  removal  of  the 
substance  and,  if  the  chemical  is  an  acid  or  an 
alkali,  its  neutralization.  To  neutralize  an  acid, 
use  an  alkali,  such  as  a  solution  of  sodium  bicar- 
bonate (baking  soda)  or  sodium  carbonate  (wash- 
ing soda)  diluted  ammonia  water,  lime  water,  or 
strong  soap  suds.  For  carbolic  acid  (which  is  not 
a  true  acid)  use  alcohol.  For  alkalies  use  a  diluted 
acid,  preferably  lemon  juice  or  vinegar.  If  the 
neutralizing  agent  cannot  be  obtained  immediately 
hold  the  part  under  running  water,  so  that  the  acid 
or  alkali  will  be  diluted  and  washed  off  and  its 
action  thus  minimized,  but  use  the  neutralizing 
agent  as  soon  as  possible. 

Burns  from  mustard  are  almost  always  due  to 
the  improper  use  of  this  substance  in  pastes  and 
poultices,  either  too  much  mustard  is  used,  or  the 
application  is  left  on  too  long,  or  the  skin  is  not 
washed  after  the  application  is  removed  and  the 


Frost-bite.     Chilblain         327 

adherent  particles  of  mustard  continue  to  act. 
The  treatment  consists  in  removing  the  mustard 
by  irrigating  and  gently  patting  the  part  with 
warm  dilute  soap  suds  and  then  warm  water, 
drying  it,  and  applying  a  dressing  of  bland  oil  or  an 
ointment  such  as  those  previously  mentioned. 

Tincture  of  iodine  is  most  easily  removed  with 
ammonia  water,  but  alcohol  or  warm  soap  suds  will 
answer  fairly  well.  If  the  skin  is  blistered  or  seems 
likely  to  become  so  apply  a  bland  oil  or  ointment. 

Consequences  of  Exposure  to  Cold,  Freezing,  or 
Frost-bite.    Chilblain 

Cold  depresses  living  tissue,  whether  vegetable 
or  animal ;  it  lessens  the  movement  of  the  molecules 
of  which  protoplasm  is  composed,  and,  thereby, 
causes  contraction  of  matter  and  inhibits  all  vital 
(life)  processes.  If  the  cold  is  not  excessive,  how- 
ever, or  exposure  too  prolonged,  as  stated  in 
Chapter  VI,  cold,  by  stimulating  nerve  endings  in 
the  skin,  produces  conditions  that  protect  the 
body  from  its  depressant  influence.  If,  however, 
exposure  to  intense  cold  is  prolonged,  the  blood  is 
driven  to  the  interior  of  the  body;  the  surface  of 
the  body  becomes  stiff,  contracted,  and  pale,  es- 
pecially the  more  exposed  parts  and  those  in  which 
the  circulation  is  first  interfered  with,  namely,  the 
face,  hands,  and  feet,  if  the  exposure  continues  the 
circulation  of  blood  in  the  brain  is  inhibited  and 
the  person  becomes  drowsy  and  finally  unconscious. 


328  Nursing  Methods 

Localized  areas,  especially  parts  of  the  face, 
hands,  and  feet  may  be  severely  frozen,  however, 
without  the  onset  of  symptoms  of  general  depres- 
sion, especially  if  the  individual  is  exercising  and 
warmly  clad. 

In  the  first  stage  of  freezing,  the  affected  part  is 
blue,  numb,  and  stiff,  later  it  becomes  white  and 
rigid  and,  if  this  stage  is  allowed  to  progress,  the 
vitality  of  the  cells  may  be  so  reduced  that  the 
tissues  will  never  recover,  but  gradually  slough 
and  die,  that  is,  they  become  gangrenous. 

The  walls  of  the  blood-vessels  in  a  frozen  part 
are  in  such  a  condition  that,  when  the  part  is 
thawed,  they  cannot  respond  to  nerve  impulses 
and  contract,  and  this,  as  the  circulation  is  restored, 
interferes  with  the  flow  of  blood  through  them, 
thus  they  become  congested  and,  consequently, 
the  part  becomes  red  and  swollen,  and  there  is 
excessive  exudation  of  fluid  into  the  tissues  and 
between  the  true  skin  and  the  outer  layer  of  skin ; 
this  separates  the  latter  from  the  underlying  struc- 
tures and  forms  blisters. 

If  the  flow  of  blood  to  a  frozen  part  is  increased 
quickly  the  conditions  described  in  the  preceding 
paragraph  will  be  worse  than  if  the  circulation  is 
restored  gradually  and  the  vessels  are  given  time 
to  resume  at  least  a  moderate  degree  of  contrac- 
tion. Thus  it  can  be  seen  that  the  severity  of  the 
after-effects  of  freezing  depend  upon  the  intensity 
of  the  freezing  and  the  rapidity  with  which  thaw- 
ing is  promoted. 


Frost-bite.     Chilblain         329 

Chilblain:  After  a  part  has  been  frozen,  exposure 
to  even  a  moderate  degree  of  cold  is  likely  to  induce 
a  condition  similar  to  the  after-effects  of  freezing 
in  which  the  part  becomes  red  or  mottled  and 
more  or  less  swollen,  and  is  intensely  itchy  and, 
especially  if  the  chilled  part  is  warmed  quickly, 
small  blisters  may  form.  This  condition  is  known 
as  chilblain.  People  with  poor  circulation  may 
suffer  from  chilblain  even  when  the  affected  part 
has  never  been  frozen. 

The  aim  of  the  primary  treatment  of  frost-bite 
is  to  restore  the  circulation  in  the  affected  part 
gradually.  Formerly  it  was  customary  to  rub  the 
part  with  snow  or  iced  water,  but  this  is  not  now 
considered  the  best  treatment;  instead,  the  person 
is  kept  in  a  cool  room  (about  65°  F.)  and  the  frozen 
area  is  very  gently  rubbed  and,  if  possible,  im- 
mersed in  water  that  has  a  temperature  of  about 
65°  F.  After  a  time  the  temperature  of  the  water 
is  gradually  increased,  by  the  addition  of  slightly 
warmer  water;  until  it  is  about  90°  F.  No  definite 
directions  can  be  given  regarding  the  rate  at  which 
the  temperature  is  to  be  increased,  it  depends 
upon  the  severity  of  the  freezing  and  the  way  in 
which  the  tissues  respond  to  the  treatment ;  severe 
freezing  and  the  onset  of  much  congestion  require 
slow  increase  of  temperature.  If  the  frozen  area  is 
at  all  large  or  if  there  are  symptoms  of  general  ill 
effects  from  the  exposures,  a  doctor  must  be  con- 
sulted and  the  patient  put  to  bed  and,  if  necessary, 
treated  for  chills  and  shock,  except  that  heat  must 


33<>  Nursing  Methods 

not  be  applied  at  first  and,  of  course,  it  must  never 
be  put  near  the  frost-bitten  areas. 

The  after  treatment  of  frost-bite  is  usually  the 
same  as  for  burns,  but,  if  the  injury  is  at  all  severe, 
a  doctor's  advice  should  be  sought.  It  is  to  be 
remembered  that  the  treatments  mentioned  in  this 
book  are  only  those  which  can  be  given  by  inex- 
perienced people  and  that  there  are  more  com- 
plicated, but  also  more  effectual,  measures  that 
are  likely  to  be  needed  in  serious  cases  of  either 
burns  or  frost-bites. 

To  allay  the  unpleasant  sensations  induced  by 
chilblain  rub  the  parts  with  spirits  of  camphor  or 
alcohol.  Denatured  alcohol  (that  containing  sub- 
stances which  make  it  poisonous  to  drink)  can  be 
used  for  this  purpose,  the  poisons  employed  not 
being  harmful  to  the  skin. 


CHAPTER  XVI 

Removal  of  Foreign  Bodies  and  Treatment  of 
Poisoning 

Methods  of  removing  foreign  bodies  from  the  eye,  ear,  nose, 
throat,  bronchial  tubes,  and  alimentary  canal.  Nature  of  poison- 
ing and  the  first  aid  treatment  for  poisoning  by  some  of  the  more 
common  poisons. 

Removal  of  Foreign  Bodies  from  the  Eyes 

Nature  has  provided  the  eyes  with  three  very 
effective  means  of  protection  from  injury  by  for- 
eign substances;  these  are  the  eyelids,  eyelashes, 
and  the  secretion  of  the  lachrymal  or  tear  glands. 

These  glands  are  in  the  bony  cavities,  known  as 
the  orbits,  that  hold  the  eyes  and  are  situated  just 
above  the  eyeballs  at  their  outer  sides.  They 
secrete  a  watery  fluid  known  as  the  tears  which 
passes  through  small  tube-like  passages,  termed 
ducts,  to  the  free  surfaces  of  the  eyeballs.  The 
glands  are  constantly  active  and  their  secretion 
keeps  the  eyeballs  moist.  Ordinarily  we  are  not 
aware  of  the  presence  of  this  fluid  because  it  evap- 
orates very  rapidly  and  any  excess  passes  into 
minute  ducts,  at  the  inner  side  of  the  eyeballs, 
which  lead  into  the  nose.  When,  however,  the 


332  Nursing  Methods 

glands  are  stimulated,  as  they  are  when  any  for- 
eign substance  enters  the  eye,  and  by  psychic 
conditions,  as  anger,  not  only  does  a  large  amount 
flow  across  the  eyeballs  into  the  nose  but  overflows 
the  lower  lids  on  to  the  cheeks. 

If,  when  anything  gets  into  a  person's  eye, 
nature's  provisions,  the  tears,  lids,  and  lashes  were 
depended  upon  for  its  removal,  less  trouble  would 
be  caused,  but  the  almost  invariable  custom  is  to 
immediately  rub  the  eye,  which  treatment  fre- 
quently either  moves  the  substance  further  under 
the  lids  or  embeds  it  in  the  conjunctiva  (the  mem- 
brane covering  the  free  surface  of  the  eye  and  lining 
the  lids)  and  often  gives  rise  to  serious  trouble. 

Therefore,  if  dust,  a  cinder,  or  other  foreign 
substance  gets  into  the  eye  wink  the  lids  briskly, 
for  this  movement  is  likely  to  dislodge  the  speck 
and,  at  the  same  time,  blow  the  nose  forcibly,  and, 
if  necessary,  smell  something,  as  pepper,  that  will 
make  the  eyes  water. 

If  these  efforts  are  not  successful,  and  the  speck 
is  under  the  upper  lid,  grasp  the  lashes  of  this  lid 
and  draw  it  downward  so  that  the  lashes  of  the 
lower  lid  will  brush  against  its  under  surface. 

If  this  is  not  effectual  either  separate  the  lids, 
as  in  Demonstration  17,  or  get  someone  to  evert 
the  lid,  as  described  later,  and  try  to  brush  off  the 
speck,  with  the  corner  of  a  clean  handkerchief. 
If  it  does  not  come  off  readily  irrigation  of  the  eye, 
as  in  Demonstration  17,  can  be  tried.  If  these 
measures  are  not  effectual,  a  doctor  should  be  seen. 


Removal  of  Foreign  Bodies    333 

To  evert  (turn  back),  the  upper  lid  and  expose 
the  under  surface,  have  the  patient  sit  with  her 
head  tilted  backward,  stand  behind  her  and  hold 
a  match  or  similar  article  across  the  lid  (do  not 
press  on  the  eyeball),  take  the  lashes  between  the 
thumb  and  first  finger  of  your  hand  and  turn  the 
lid  backward  over  the  match. 

This  procedure  is  quite  easily  done  after  a  little 
practice,  though  it  is  rather  difficult  to  get  the 
knack,  and  the  pupils  should  practice  it.  They 
can  stand  in  front  of  a  mirror  and  each  one  do  it 
on  herself. 

Removal  of  Foreign  Bodies  from  the  Ear 

In  the  case  of  adults  it  is  usually  small  flies  or 
insects  that  get  in  the  ears,  but  children  are  in- 
clined to  put  such  things  as  peas,  buttons,  small 
stones,  and  the  like  in  their  ears. 

Filling  the  ear  with  liquid,  oil  especially,  will 
usually  kill  an  insect  and  it  will  then  float  to  the 
top  and,  if  the  head  is  bent  so  that  the  ear  being 
treated  is  downward  the  insect  will  be  washed  out. 
The  liquid  can  be  poured  into  the  ear  from  the 
bottle  or  a  medicine  dropper. 

Hard  objects  can  usually  be  picked  out  with  the 
fingers  if  they  have  not  been  pushed  in  too  far. 
In  the  latter  case,  syringing  the  ear  can  be  tried 
as  described  in  Chapter  VIII,  but  under  no  cir- 
cumstances must  the  object  be  poked  at  for  the 
membrane  between  the  outer  and  middle  ear  is 


334  Nursing  Methods 

very  easily  ruptured.  In  fact,  unless  it  is  difficult 
to  get  a  doctor,  it  is  better  for  an  inexperienced 
person  not  even  to  try  the  syringing.  Alcohol 
should  be  used  instead  of  water  or  the  solutions  in 
Chapter  VIII,  when  the  foreign  body  is  anything, 
such  as  a  pea  or  bean  that  will  absorb  water  and 
swell ;  alcohol  tends  to  shrink  such  substances. 

Removal  of  Foreign  Bodies  from  the  Nose  and 
Other  Air  Passages 

Children  quite  frequently  poke  hard  objects 
into  the  nostrils.  To  remove  one,  press  your  finger 
on  the  empty  nostril  and  make  the  child  blow  its 
nose  hard.  If  this  is  not  effectual,  unless  there  is 
someone  present  who  knows  how  to  give  a  nasal 
irrigation,  take  the  child  to  a  doctor. 

The  entrance  of  foreign  substances  into  the 
trachea  (windpipe)  is  not  an  uncommon  accident. 
The  usual  causes  are,  vomiting  while  under  the 
influence  of  an  anesthetic,  and  speaking  or  laughing 
while  there  is  something  in  the  mouth.  The  reason 
that  the  accident  occurs  so  readily  is  that  the 
esophagus  (the  tube-like  passage  leading  from 
the  throat  to  the  stomach)  is  behind  the  trachea 
(the  windpipe)  and  therefore  anything  swallowed  or 
vomited  has  to  pass  over  the  latter.  The  motion 
of  swallowing,  however,  draws  a  small  membranous 
cover  attached  to  the  back  of  the  tongue  (called 
the  epiglottis)  over  the  opening  of  the  larynx  (the 
upper  distended  part  of  the  windpipe)  and  prevents 


Removal  of  Foreign  Bodies    335 

food  getting  into  it,  but  the  movements  of  the 
tongue  and  throat  muscles  when  an  individual  is 
laughing  and  talking  are  quite  different  from  those 
made  when  swallowing  and  the  glottis  (the  open- 
ing) is  left  exposed. 

The  entrance  of  anything  into  these  air  passages 
induces  such  coughing  that  the  object  is  likely  to 
be  ejected  without  treatment,  if  it  is  not,  slap  the 
patient  on  the  back,  as  this  tends  to  dislodge  any 
foreign  substance  in  the  larynx  or  trachea  and,  if 
this  fails,  invert  the  patient.  With  an  adult,  this 
is  best  done  by  laying  her  across  a  couch  or  bed 
with  the  upper  part  of  her  body  bending  over  its 
side,  but  a  child  can  be  taken  by  its  feet  or  knees 
and  held  upside  down.  Continue  to  give  hard 
slaps  upon  the  back.  If  the  trachea  is  sufficiently 
blocked  to  cause  symptoms  of  asphyxia  and  the 
object  is  not  immediately  coughed  up,  a  doctor 
should  be  called  at  once  and,  even  though  the 
asphyxia  is  relieved,  if  the  object  is  not  coughed 
up,  a  doctor  should  be  consulted  because  the  relief 
of  the  asphyxia  may  be  due  to  some  change  in  the 
position  of  the  object  which  lessens  interference 
with  breathing  and,  if  left  alone,  the  object  may 
pass  down  into  the  lung  and  cause  serious  trouble. 

Foreign  Matter  in  the  Alimentary  Canal 

Another  not  uncommon  accident,  especially  in 
childhood,  is  swallowing  hard  or  sharp  objects 
which  cannot  be  digested.  The  latter  are  the  more 


336  Nursing  Methods 

dangerous  as  it  is  quite  possible  for  them  to  pierce 
the  wall  of  the  stomach  or  intestines.  Even  the 
former,  however,  if  large,  may  cause  trouble  by 
blocking  some  of  the  constricted  portions  of  the 
alimentary  canal,  therefore,  a  doctor  should  be 
consulted.  To  lessen  the  danger  of  trouble  from 
sharp  objects,  large  amounts  of  soft  food,  such  as 
mush,  potatoes,  and  cornstarch  preparations  should 
be  given  as  soon  as  possible.  No  cathartic  should 
be  taken  until  ordered  by  the  doctor. 

Nature  of  Poisons  and  First  Aid  Treatment  for 
Poisoning 

A  poison  is  generally  denned  as  any  substance 
that,  in  relatively  small  amounts,  may  cause  death 
or  disease. 

As  previously  stated,  poisons  may  be  taken  into 
the  body  (ingested)  or  formed  within  the  body. 
Only  the  former  will  be  considered  here. 

Ingested  poisons  are  usually  either  chemicals 
used  as  medicines  or  in  industries,  poisons,  plants, 
or  toxic  substances  developed  in  food  as  the  result 
of  decomposition. 

A  poison  may  be  taken  by  accident  or  deliber- 
ately, with  the  intent  to  commit  suicide,  also,  it 
may  be  administered  by  mistake  or  with  criminal 
intent. 

Poisons  are  sometimes  classified  under  two 
primary  headings,  namely,  those  which  produce 
harmful  effects  in  the  alimentary  canal  and  those 


Treatment  for  Poisoning       337 

which  act  only  after  they  have  been  absorbed  by 
the  blood  and  carried  about  the  body.  The  latter 
class  is  subdivided  into  (i)  those  which  act  as  de- 
pressants (drugs  used  to  induce  sleep  and  to  alle- 
viate pain)  and  those  which  act  as  stimulants,  but 
even  stimulants,  in  poisonous  doses,  usually  cause 
death  by  depressing  either  the  nervous  system  or 
the  heart  muscle  or  both,  because  over-activity  of 
any  part  of  the  body  is  followed  by  its  fatigue  and 
consequent  inability  to  function  properly  and  the 
nervous  system  and  in  some  cases,  the  heart  muscle 
are  more  easily  affected  by  such  drugs  than  other 
tissues.  Depression  of  these  parts  of  course  results 
in  shock. 

Death  from  poisoning  is  nearly  always  due  either 
to  shock  or  to  interference  with  breathing,  and  the 
interference  with  breathing  is  usually  the  result 
either  of  depression  of  the  respiratory  center  or  of 
spasmodic  contractions  of  the  chest  muscles  during 
convulsions. 

Irritant  drugs  (examples  of  which  are  given  on 
page  341)  will  cause  shock  by  their  actions  in  the 
alimentary  canal ;  these  are :  Intense  inflammation 
and,  sometimes,  corrosion  of  the  membrane  lining 
the  canal,  excessive  vomiting  and  diarrhea.  The 
reasons  why  such  actions  induce  shock  were  men- 
tioned in  the  section  describing  the  causes  of  shock. 
Some  of  them  also  depress  the  nervous  system  after 
absorption. 

The  local  action  of  irritant  drugs  will  be  in  pro- 
portion to  their  strength ;  for  example,  a  teaspoonf  ul 


338  Nursing  Methods 

of  50  per  cent,  hydrochloric  acid  will  do  infinitely 
more  harm  to  the  membrane  with  which  it  comes 
in  contact  than  three  times  that  amount  of  10  per 
cent,  hydrochloric  acid,  but  a  poisonous  dose  of 
strychnine  will  be  as  poisonous  in  a  quart  of  water 
as  in  a  teaspoonful  of  water. 

Symptoms  of  poisoning:  It  would  be  almost 
impossible  for  anyone  not  accustomed  to  observing 
the  effects  of  drugs  to  remember  or  recognize  all 
the  symptoms  of  poisoning  produced  by  individual 
drugs  and,  therefore,  only  those  characteristic  of 
the  different  types  will  be  mentioned  here. 

The  characteristic  symptoms  of  poisoning  by 
irritants  are:  Intense  abdominal  pain,  nausea, 
vomiting,  diarrhea  and,  after  a  time,  there  will 
probably  be  blood  and  shreds  of  mucous  membrane 
in  the  vomitus  and  feces  and,  later,  in  the  urine.1 
The  mucous  membrane  of  the  mouth  and  throat 
will  be  intensely  red  and  sometimes  swollen  and, 
especially  if  a  corrosive  drug,  as  a  concentrated 
acid,  has  been  taken  the  membrane  may  look  as 
though  it  had  been  burned,  and  it  may  be  dis- 
colored. Also,  the  symptoms  of  shock  mentioned 
on  page  263  will  soon  be  apparent.  There  may  be 
convulsions. 

The  characteristic  symptoms  of  poisoning  by 

'Almost  all  drugs  and  other  poisonous  substances  are  elimi- 
nated chiefly  through  the  kidneys,  and  even  irritants  that  are  too 
thoroughly  diluted  by  the  blood  after  they  are  absorbed  to  injure 
other  tissues  may  affect  the  kidneys  and  other  urinary  organs 
because  they  are  here  once  more  present  in  concentrated  amounts, 
though,  of  course,  not  quite  as  much  so  as  in  the  alimentary  canal. 


Treatment  for  Poisoning       339 

the  majority  of  depressant  drugs  (those  used  to 
relieve  pain  and  induce  sleep)  are  profound  stupor ; 
slow,  shallow  breathing;  the  symptoms  of  shock; 
and,  as  the  breathing  becomes  insufficient,  the 
symptoms  of  asphyxia  become  more  or  less  pro- 
nounced. 

In  poisoning  by  opium  and  its  alkaloids1  the 
symptoms  are  somewhat  different  from  those 
induced  by  other  depressants  because  these  drugs 
depress  the  parts  of  the  brain  concerned  with  sen- 
sation and  breathing  more,  and  other  parts  less, 
than  the  other  depressants.  The  chief  differences 
are :  The  breathing  becomes  excessively  slow  in  the 
early  stages  of  poisoning  and,  therefore,  the  symp- 
toms of  asphyxia  are  especially  marked  while  the 
symptoms  of  shock  are  not  observed  until  shortly 
before  death ;  in  fact  many  patients  cease  breathing 
while  the  pulse  is  still  fairly  strong;  and  if  the 
patient  is  kept  walking  about  or  otherwise  aroused, 
stupor  is  less  profound  than  that  induced  by  the 
other  depressants;  the  pupils  of  the  eyes  are  con- 
tracted until  shortly  before  death  when  they  dilate 
widely. 

Characteristic  symptoms  of  poisoning  by  poi- 
sons that  cause  death  by  over  stimulating  the 
nervous  system  are :  Muscular  twitching,  convul- 
sions, and,  sometimes,  delirium.  Finally  there  will 

1  Alkaloids  are  organic,  nitrogenous  substances  that  combine 
with  acids  to  form  salts.  A  large  number  of  the  most  poisonous 
drugs  owe  their  effects  to  these  substances.  Well-known  examples 
are:  Morphine  and  codeine  (derived  from  opium),  strychnine 
(from  nux  vomica),  atropine  (from  belladonna). 


34°  Nursing  Methods 

be  stupor  and  the  symptoms  of  shock  but  these  will 
not  occur  as  quickly  as  in  poisoning  by  depressants. 
Commonly  used  drugs  which  act  in  this  manner 
are:  Strychnine,  mix  vomica,  belladonna,  and 
atropine. 

The  symptoms  of  poisoning  by  poisonous  mush- 
rooms and  some  putrefied  foods  (ptomaine  poi- 
soning) are:  Intense  abdominal  pain,  nausea, 
vomiting,  purging,  the  symptoms  of  shock,  thirst 
becomes  extreme,  and,  especially  if  the  patient  is 
a  child,  there  may  be  convulsions. 

There  is  also  a  form  of  food  poisoning,  Known 
as  botulism, *  that  is  caused  by  eating  food  infected 
with  a  microorganism,  the  bacillus  botulus.  Sau- 
sages and  canned  meats  and  vegetables,  especially 
peas  and  beans,  that  are  not  well  sterilized  when 
prepared  are  common  causes  of  poisoning,  because 
these  foods  are  quite  frequently  infected  with  the 
organism,  and,  if  it  is  not  destroyed,  it  multiplies 
and  increases  in  virulency  during  the  period  that 
the  foods  are  preserved.  The  symptoms  do  not 
usually  appear  for  some  hours  after  the  infected 
food  is  eaten  and  they  vary  considerably  according 
to  the  degree  of  infection.  They  are  likely  to  be 
digestive  disturbances  followed  by  collapse,  ex- 
treme dryness  of  the  mucous  membrane  of  the 
mouth  and  throat,  dilation  of  the  pupils,  and  there 
may  be  convulsions  or  paralysis. 

Treatment  for  poisoning:  Send  for  a  doctor 
instantly  and,  if  anybody  who  knows  how  to  wash 

1  Latin  botulus  =  sausage. 


Treatment  for  Poisoning       34 l 

out  the  stomach  can  be  reached  quicker,  get  her 
or  him,  for  lavage  (washing  out  the  stomach)  is  one 
of  the  first  and  most  important  things  to  be  done 
in  the  treatment  of  practically  all  poisoning  when 
the  poison  has  been  taken  by  mouth  and,  in  the 
case  of  some  drugs,  especially  opium  and  its  alka- 
loids and  arsenic,  even  when  the  drug  has  been 
taken  in  other  ways,  as  by  a  hypodermic  injection, 
because  these  drugs  are  excreted  into  the  intes- 
tines, as  well  as  through  the  kidneys. 

The  treatment  that  an  inexperienced  person 
should  give  while  awaiting  help  is  as  follows : 

For  poisoning  by  irritants :  (This  includes  some 
of  the  most  common  causes  of  poisoning,  the  chief 
ones  are  arsenic  compounds;  corrosive  acids,  in- 
cluding carbolic  and  oxalic;  corrosive  alkalies, 
which  includes  many  compounds  of  sodium,  po- 
tassium, and  calcium  or  lime,  and  bichloride  of 
mercury.)  Dilute  the  poison  at  once  (it  is  to  be 
remembered  that  the  irritant  action  of  these  com- 
pounds is  in  proportion  to  their  concentration  and, 
if  they  are  diluted  promptly  their  ill  effects  will  be 
minimized) ;  if  possible  use  the  chemical  antidote 
(mentioned  later)  or  milk  or  white  of  uncooked 
egg  for  the  dilution,  but,  if  water  can  be  obtained 
quicker,  give  water  and  get  the  other  liquids  later, 
not  a  second  must  be  lost.  The  milk  and  egg  coat 
the  surface  of  the  membrane  lining  the  alimentary 
canal  and  protect  it  from  the  action  of  the  irritant, 
also  their  albumin  combines  with  a  number  of  the 
irritant  drugs  and  reduces  their  irritant  properties. 


342  Nursing  Methods 

Other  good  protectors  for  the  membrane  are  starch 
water1  and  gelatine  dissolved  in  warm  water.  Give 
as  much  of  these  protective  fluids  as  possible,  even 
though  they  are  vomited. 

By  a  chemical  antidote  is  meant  a  substance  that 
will  combine  with  a  poison  and  change  it  to  harm- 
less or,  at  least,  a  less  harmful  compound.  There 
are  only  certain  poisons,  however,  for  which  such 
antidotes  are  known. 

The  chemical  antidote  for  acids  (except  carbolic 
acid)  are  alkalies. a  The  best  alkali  to  use  is  milk  of 
magnesium  (one  to  two  tablespoonsful,  according 
to  the  amount  of  acid  taken),  but,  if  magnesium 
cannot  be  obtained,  sodium  bicarbonate  (baking 
soda),  sodium  carbonate  (washing  soda),  (quarter 
to  half  a  teaspoonful  in  half  a  glass  of  water), 
ammonia  water,  soap,  wall  plaster,  lime  water  (one 
to  two  glasses  full)  can  be  used.  An  objection  to 
the  carbonates  is  that,  when  they  come  in  contact 
with  acid,  they  liberate  carbon  dioxid  gas  and,  if 
the  stomach  is  corroded  by  the  acid,  this  may  be 
harmful.  Ammonia  is  irritating  and  therefore 
should  only  be  used  if  other  alkalies  cannot  be 
obtained,  if  necessary  to  use  it,  dilute  it  well,  using 

1  To  make  the  paste  mix  two  teaspoonsful  of  cornstarch  with 
cold  water,  add  about  a  cupful  of  boiling  water  slowly,  stirring 
the  mixture  as  you  pour  on  the  water;  boil  the  mixture  for  at  least 
five  minutes  and  then  cool  it  and  make  it  thin  enough  to  drink  by 
adding  cold  water  or,  preferably,  milk. 

'Acids  and  alkalies  interact  and  form  salts.  Carbolic  acid  is 
not  a  true  acid  and  does  not  combine  with  alkalies  but  it  does 
with  alcohol. 


Treatment  for  Poisoning       343 

about  one  teaspoonful  in  a  glassful  of  water.  Do 
not  use  the  soda  compounds  for  poisoning  by  oxalic 
acid  because  the  sodium  oxalates  (salts  of  oxalic 
acid)  are  about  as  poisonous  as  the  acid. 

The  chemical  antidote  for  carbolic  acid  is  alcohol. 
It  is  generally  given  in  the  form  of  whiskey  or 
brandy,  but  wines  can  be  used,  though  they  must 
be  given  in  larger  amounts.  Though  alcohol  pre- 
vents the  local  action  of  carbolic  it  hastens  the 
absorption  of  the  drug  and  does  not  prevent  the 
action  of  carbolic  after  absorption,  therefore,  if 
nobody  to  wash  out  the  stomach  can  be  found, 
after  giving  alcoholic  drinks  freely,  and  a  protective 
as  white  of  uncooked  egg,  cause  vomiting  in  one 
of  the  ways  described  later,  except  by  the  use  of 
mustard,  which  is  too  irritating  to  use  in  the  treat- 
ment of  poisoning  by  an  irritant. 

The  chemical  antidote  for  bichlorid  of  mercury 
and  other  metal  salts  is  albumin,  which  is  con- 
tained in  white  of  egg  and  milk. 

The  chemical  antidote  for  alkaloids  is  tannin. 
This  is  contained  in  tea  leaves  and,  if  the  leaves  are 
boiled,  a  considerable  amount  can  be  extracted. 
As  previously  stated  the  poisonous  principles  of  a 
large  number  of  the  vegetable  drugs  are  alkaloids. 

When  the  patient  is  discovered  before  she  is 
having  convulsions  or  the  symptoms  of  shock  are 
pronounced,  the  first  thing  to  be  done  in  the  treat- 
ment for  poisoning  by  drugs  that  act  after  absorp- 
tion is  to  cause  vomiting.  Vomiting  can  be  induced 
by  tickling  the  back  of  the  throat  with  your  finger, 


344  Nursing  Methods 

a  stick,  feather,  pencil,  etc.,  or  by  giving  an  emetic 
(i.e.,  a  remedy  that  causes  vomiting).  Mustard, 
one  teaspoon  in  half  a  glassful  of  water,  is  one  of 
the  most  efficient  emetics  that  anyone  not  ac- 
quainted with  the  use  of  drugs  can  use,  but  salt,  one 
teaspoon  in  a  glassful  of  tepid  water,  or  tepid  water 
alone  will  often  induce  vomiting.  As  soon  as  the 
patient  has  vomited  give  strong  boiled  tea,  then 
induce  vomiting  again  and  if  the  poisoning  is  due 
to  a  depressant,  give  more  tea  and  strong  coffee 
(for  the  sake  of  their  caffeine)  but  do  not  use  these, 
except  the  tea  that  is  vomited  (which  is  used  for  its 
tannin)  when  the  poisoning  is  due  to  the  nerve 
stimulants  mentioned  on  page  340,  because  they 
contain  caffeine  which  is  a  nerve  stimulant  and 
would  therefore  increase  the  harmful  effects.  For 
these  give  sodium  bromide  thirty  grains  in  about  a 
quarter  of  a  glass  of  water. 

If  the  symptoms  of  collapse  are  pronounced,  or 
the  patient  is  having  convulsions,  except  in  the 
case  of  poisoning  by  opium  and  its  alkaloids,  do  not 
give  an  emetic,  for,  as  the  drug  must  have  been 
absorbed  if  the  conditions  of  poisoning  are  pro- 
nounced, vomiting  will  do  little  good  and  may  do 
harm.  Therefore,  all  that  can  be  done  until  help 
arrives,  in  the  case  of  poisoning  by  depressants,  is 
to  treat  the  patient  for  shock  and  give  all  the  strong 
coffee  possible;  if  the  patient  cannot  take  it  by 
mouth  give  it  by  rectum,  you  can  do  so  with  a 
long-nozzled  syringe,  or  by  inserting  a  rectal 
tube,  or,  if  one  is  not  at  hand,  a  piece  of  rubber 


Treatment  for  Poisoning      345 

tubing  about  four  to  six  inches  in  the  rectum 
(according  to  the  size  of  the  patient)  and  pouring 
the  coffee  very  slowly  into  this.  If  possible  put  a 
funnel  in  the  free  end  of  the  tubing  as  this  will 
facilitate  pouring  in  the  coffee,  or  a  fountain 
syringe  bag  with  its  attached  tubing  can  be  used. 
Grease  the  tubing  with  vaselin  or  cold  cream  or 
other  lubricant  before  inserting  it  in  the  rectum. 
Do  not  hold  the  funnel  or  bag  more  than  twelve 
inches  above  the  rectum.  Give  artificial  respira- 
tion if  necessary. 

If  the  patient  is  having  convulsions  as  the  result 
of  poisoning  by  nerve  stimulants  it  is  most  impor- 
tant to  get  help  immediately  because,  especially 
in  the  case  of  strychnine  poisoning,  the  patient 
usually  has  to  be  given  an  anesthetic  before  treat- 
ment can  be  given,  for  the  slightest  stimulus,  any 
movement,  a  light,  a  noise,  may  cause  a  convulsion. 
While  waiting  for  help  see  that  the  patient  is  kept 
very  quiet  in  a  darkened  room. 

The  principal  items  in  the  first  aid  treatment  for 
poisoning  by  opium  and  its  alkaloids  are :  Empty 
the  stomach  repeatedly,  at  intervals  of  about  every 
half  hour  (these  drugs  are  alternately  absorbed 
and  eliminated  back  into  the  intestines);  give  a 
cathartic — magnesium  sulphate  (epsom  salt),  half 
ounce  (two  tablespoonsful)  in  about  half  a  glass  of 
water,  is  generally  considered  one  of  the  best 
cathartics  to  use  for  the  purpose ;  keep  the  patient 
awake  by,  if  possible,  walking  her  up  and  down 
and  giving  her  strong  coffee.  If  you  cannot  keep 


346  Nursing  Methods 

her  awake  until  help  arrives,  it  will  probably  be 
necessary  to  give  artificial  respiration. 

The  first  aid  treatment  for  poisoning  by  poison- 
ous foods  is  to  cause  vomiting,  as  described  on 
page  343;  to  treat  the  patient  for  shock;  to  give  all 
the  liquid  possible,  including  tea  and  coffee,  and  a 
large  dose  of  castor  oil. 

It  is  to  be  remembered  that  in  all  cases  of  poison- 
ing, lavage  of  the  stomach  is  better  than  an  emetic 
because  it  is  less  depressing  to  the  patient  and  it 
removes  material  from  the  stomach  more  thor- 
oughly. It  is  also  to  be  realized  that  the  treatment 
described  in  these  pages  only  includes  the  measures 
that  can  be  carried  out  by  a  person  inexperienced 
in  the  use  of  drugs  and  the  care  of  the  sick  and  that 
a  doctor,  and,  though  to  a  lesser  extent,  a  nurse  or 
druggist  can  give  further  treatment.  Therefore, 
help  must  be  sent  for  at  once,  but  the  measures 
given  here  must  be  taken  in  the  meantime,  for  every 
second  lost  in  diluting  an  irritant  drug  increases  the 
injury  to  the  tissue  and  thus  increases  the  chances 
of  death  or,  if  the  patient  is  saved,  life-long  trouble 
from  the  scars  that  will  form  in  the  alimentary 
tract;  and,  if  non -irritant  poisons  are  removed  by 
lavage  or  vomiting  before  they  are  absorbed,  the 
individual  may  not  be  any  the  worse  for  having 
taken  the  poison,  but,  many  of  these  drugs  are 
absorbed  so  quickly  that  the  conditions  of 
poisoning  will  be  present  in  from  five  to  twenty 
minutes. 

From  what  has  been  said  regarding  the  treat- 


Treatment  for  Poisoning      347 

ment  for  poisoning  it  can  be  seen  that  the  aims 
of  the  treatment  are : 

(1)  To  dilute  irritant  drugs. 

(2)  To  remove  the  drug. 

(3)  To  use  something  that  will  render  the  drug 
harmless  or  at  least  less  harmful. 

(4)  To  take  means  to  overcome  the  bad  effects 
that  the  poison  has  produced. 


GLOSSARY 

Abnormal.     Not  normal;  not  according  to  the  usual  condition. 

Acute.  Short;  rapid;  having  a  short  and  relatively  severe  course, 
the  opposite  of  chronic. 

Agglutination.    Sticking  or  gluing  together. 

Alimentary  Canal.  The  canal  through  which  the  food  passes 
and  is  digested.  It  consists  of  the  mouth,  pharynx  (throat), 
esophagus,  stomach,  and  intestines. 

Alleviate.    To  mitigate,  to  lessen. 

Amputation.    The  removal  of  a  part  of  the  body. 

Analogous.     Having  the  same  function  or  meaning. 

Anemia.  An  abnormal  condition  of  the  body  in  which  there  is 
either  a  deficiency  of  blood — as  following  hemorrhage — or  a 
deficiency  of  red  blood  corpuscles  or  of  hemoglobin. 

Anesthetic.  A  drug  that  produces  anesthesia,  i.  e.,  lessened 
sensation. 

Anterior.     In  front  of. 

Antiseptic.  An  agent  that  prevents  the  activity  and  multiplica- 
tion of  microorganisms. 

Antitoxin.  A  substance  that  will  destroy  the  toxins  (poisons) 
produced  by  bacteria.  Such  substances  are  produced  in  the 
animal  body  as  the  result  of  infection  by  bacteria  or  their 
toxins. 

Anus.  The  opening  to  the  external  end  of  the  rectum,  i.  e.,  the 
lower  part  of  the  bowel. 

Apposition.    The  state  of  being  fitted  together. 

Arteries.  The  blood-vessels  through  which  the  blood  flows  from 
the  heart  to  the  capillaries. 

Asepsis.    Absence  of  septic  matter,  freedom  from  infection. 

Asphyxia.    Suffocation. 

Assimilation.  To  absorb  or  incorporate;  the  transformation  of 
food  derivatives  into  living  tissue,  i.  e.,  constructive  metab- 
olism. 

349 


350  Glossary 

Astringent.    A   substance  which  produces  contraction  of  the 

tissues  and  lessens  secretions. 

Atrophy.     The  wasting  or  diminution  in  the  size  of  a  part. 
Auditory.     Pertaining  to  hearing. 

Base.  The  foundation;  the  chief  ingredient  of  a  compound;  a 
metal  element  or  compound  that  will  unite  with  an  acid  to 
form  a  salt. 

Basic.     Pertaining  to  a  base. 

Bronchi.  The  bronchial  tubes  which  extend  from  the  trachea 
(windpipe)  to  the  lungs. 

Capillaries.    The  small  blood-vessels  between  the  arteries  and 

the  veins;  small  lymph  vessels. 
Complicated.    Complex;   associated   with   another   disease  or 

injury. 

Condense.    To  make  more  compact  or  concentrated. 
Condiment.     A  seasoning  or  sauce  used  to  improve  the  flavor  of 

food. 

Conduction.     The  act  of  conveying  or  leading. 
Congestion.    An  excessive  accumulation  of  blood  in  a  part. 
Contagion.     The  contraction  of  a  disease  by  contact  with  infected 

matter  or  with  a  person  suffering  with  the  disease. 
Contiguous.     Close  together. 
Contused.     Bruised. 

Converge.     To  come  to  a  point  or  close  together. 
Corrosion.    The  process  or  act  of  disintegrating  or  wearing  away 

by  degrees. 

Defecation.    The  discharge  of  feces  from  the  rectum. 

Demulcent.     Bland;  soothing. 

Dense.    Thick;  compact. 

Denude.     To  lay  bare;  to  remove  the  covering. 

Depressant.    Anything  that  diminishes  the  force  or  strength  of 

a  body. 

Detergent.    A  cleansing  agent. 
Diffuse.    To  spread. 
Diluent.     An  agent  used  to  dilute  or  render  a  solution,  etc.,  less 

concentrated. 
Disinfectant.    An  agent  that  will  kill  microorganisms. 


Glossary  35 l 

Distal.     Remote  from  the  center  or  origin. 
Drastic.     Severe;  a  powerful  purgative. 

Duct.  A  channel  or  tube  for  the  passage  of  secretions  or  ex- 
cretions from  a  gland. 

Eczema.  A  non-contagious  inflammation  of  the  skin  charac- 
terized by  lesions  of  various  kinds. 

Efferent.     To  carry  outward. 

Eliminate.     To  expel. 

Emetic.    A  drug  or  other  agent  that  causes  ernesis,  i.  e.,  vomiting. 

Engorged.     Congested. 

Enzymes.  Organic  substances  that  are  produced  by  living  cells 
and  act  as  catalyzers,  i.  e.,  they  hasten  chemical  reactions, 
but  do  not  themselves  enter  into  the  reaction. 

Epidemic.  A  disease  that  spreads  rapidly  through  a  community 
or  becomes  widely  diffused. 

Epidermis.    The  outer  skin. 

Excreta.     Waste  matter  discharges  from  the  body. 

Extravasation.     The  escape  of  blood  or  fluid  from  a  vessel. 

Exudation.  The  passage  of  fluid  through  the  walls  of  the  blood- 
vessels. 

Feces.  The  waste  matter  that  is  discharged  through  the  intestines. 

Gray  matter.  The  part  of  nervous  tissue  which  contains  the 
cell-bodies. 

Host.  Any  organism  or  plant  upon  which  another  organism 
lives  parasitically. 

Immune.     Protected  against  any  particular  disease. 

Incompatible.     Not  suitable  for  combination. 

Infection.     The  communication  of  disease  from  one  person  to 

another;  the  implantation  of  disease;  contamination. 
Ingest.    To  take  into  the  stomach. 
Inherited.    Obtained  from  an  ancestor. 
Innervation.     The  distribution  of  nerves  in  a  part. 
Inoculate.    To  introduce  a  virus  into  any  substance. 
Insidious.     Deceitful;  lurking. 

Lacerated.    Torn. 
Lubricate.    To  make  smooth. 


352  Glossary 

Maceration.     The  softening  of  a  substance  by  soaking  in  a  liquid. 

Medium.  An  agency  of  transmission  or  communication;  sur- 
roundings; any  substance  in  which  bacteria  are  grown. 

Mobility.     Capable  of  being  moved. 

Molecule.  The  smallest  part  of  a  compound  that  can  exist  and 
maintain  its  chemical  features. 

Moribund.     In  a  dying  state. 

Mucous  Membrane.  The  thin  layer  of  tissue  lining  the  canals 
and  cavities  of  the  body  that  communicate  with  the  external 
air. 

Nerve  Centers.  A  mass  of  nerve  cells  that  control  or  help  to 
control  some  special  function,  as  breathing,  swallowing,  etc. 

Nerve  Reflexes.  Involuntary  actions,  movements,  or  secretion 
induced  by  the  stimulation  of  sensory  nerves  which  transmit 
the  stimuli  to  the  efferent  nerves  and  thus  to  the  muscles  or 
glands. 

Neutralize.  To  render  neutral,  i.  e.(  neither  acid  nor  alkalie;  to 
render  ineffective. 

Normal.    Typical;  healthy. 

Obliterate.    To  wipe  out. 

Omnipresent.     Everywhere. 

Oxidation.     The  union  of  oxygen  with  matter. 

Pallor.     Paleness. 

Parasite.    An  animal  or  plant  that  lives  at  the  expense  or  is 

nourished  by  another  animal  or  plant. 
Pathogenic.     Producing  disease. 
Pathologic.     Pertaining  to  disease. 
Periphery.    The  outward  part  or  surface. 
Physiologic.      Pertaining  to  the  functions  of  the  body. 
Protoplasm.    The  essential  constituent  of  the  living  cells  of  body 

tissues. 

Radical.  A  group  of  elements  common  to  a  series  of  allied 
compounds  that  act  as  a  unit  in  a  chemical  reaction;  extreme 
measures;  the  root  or  source. 

Reaction.    The  response  which  a  part  makes  to  stimulation. 

Reproduction.    The  production  of  offspring. 


Glossary  353 

Secretion.    A  substance  formed  by  secretory  cells  from  material 

taken  from  the  blood;  the  act  of  forming  a  secretion. 
Sequela.     An  abnormal  condition  following  and,  either  directly 

or  indirectly,  caused  by  a  disease. 
Simulated.     To  assume  the  likeness  of;  to  pretend. 
Sterile.    Free  from  microorganisms;  barren. 
Stimulate.   To  excite  or  rouse. 
Stimulus.    Anything  which  is  capable  of  producing  physiologic 

reaction. 

Symptoms.    Signs. 

Synthesis.    Building;  putting  together. 
Systemic.     Affecting  or  pertaining  to  the  whole  body  or  a  special 

system  of  the  body,  e.  g.,  the  respiratory  system,  the  vascular 

system. 

Tone.      The  state  of  the  body  in  which  all  of  its  parts  are  in  a 

normal  state  of  tension  and  vigor. 
Transudation.     The  passage  of  matter  though  a  membrane  or 

other  porous  substance. 

Urine.     The  excretion  of  the  kidneys. 

Vaccination.     To  inoculate  with  a  virus  so  as  to  obtain  immunity 

from  a  disease. 
Vacuum.    A  space  from  which  all  air  has  been  removed  and 

which  contains  no  material  substance. 
Virulent.     Poisonous;  malignant. 
Virus.     Poisonous  matter  produced  by  disease  and  capable  of 

propagating  that  disease. 
Vital.     Pertaining  to  life. 
Vitiation.     Impairment  of  a  substance  or  process  that  lessens  its 

efficiency. 

Volatile.     Tending  to  evaporate  rapidly. 
23 


INDEX 


Air,  how  purified,  12 

impurities  in,  1 1 
Antidote   for  poisons,  342 
Antiphlogistin  poultice,  191 
Apoplexy,  271,  272 
Artificial  respiration,  282 
Asphyxia,  281 

Asphyxiated,    how    to    avoid 
becoming,  323 

Back,  how  to  rub,  6 1 

how  to  wash,  61 
Bacteria,  how  to  destroy,  32 

how  transmitted,  32 
Bandage,  arm,  250 

circular,  245 

elbow,  250 

figure-eight,  246 

foot,  247 

hand,  251,  253 

heel,  247 

leg,  248 

recurrent,  247 

shoulder,  249 

spiral,  245 

spiral  reverse,  245 
Bandages,  handkerchief,  256 

how  to  make,  242 

material  for,  241 

tail,  256 

uses  of,  24 1 

Bandaging,   important   points 
to  remember  when,  243 


Bath,  action  of  cold,  93 

action  of  hot,  91 

action  of  warm,  97 

cleansing,  98 

eye,  170 

infant's,  219 

points   to   remember   when 

convalescent  takes,  103 
Baths,  uses  of,  90 
Bedclothes,  how  to  disinfect, 

36 

Bedding,    suitable    for    sick- 
room, 9 
Bed,  ideal  for  sick-room,  8 

location  of,  9 

making,  46-58 
Bedpan,    how    to    clean,    29, 

65 
how  to  give  and  remove,  63 

Bedsores,  67 

Bottles,  care  of  infant's  feed- 
ing, 230 

Breathing,  132,  279 

Burning,  nature  of,  321 

Burns,  324 

Carriers  of  infection,  24 

Carrying  a  patient,  methods 

of,  44 
after  an  accident,  265 

Chair,  making  a  patient  com- 
fortable in  a,  83 

Chilblain,  329 


355 


356 


Index 


Children,  appropriate  clothing 
for,  24 

normal  development  of,  106 

proper  diet  for,  213 
Chills,  275 
Chloride  of  lime,  34 
Cold,  action  of,  327 
Cold  compresses,  181 
Cold,    how   to   avoid   taking, 

95 

Colds,  causes  of,  95 

Collapse,  260,  265 

Comfort,  essentials  for  a  pa- 
tient's, 66 

Congestion,  68,  289 

Convulsions,  270,  274 

Demonstrations,  list  of,  359 
Diaphragm,  134 
Discomfort,  causes  of,  67 
causes  of  in  badly  ventilated 

rooms,  1 6 

Disease,  how  transmitted,  22 
Disinfection,   important   rules 

to  remember  in  connection 

with,  35 
nature  of,  32 
Dislocations,  308 
Drowning,  treatment  of  person 

rescued  from,  285 
Drugs,  how  given,  140 

Ear,  common  abnormal  condi- 
tions of,  161 
how  to  remove  foreign  body 

from,  333 
irrigation  of,  162 
structure  of,  157 
Electric  pads,  180 
Epilepsy,  272,  273 


Equipment  for  demonstration 

room,  i 
for  demonstrations,  see  list, 

359 

Eye,  abnormal  conditions  of, 

165 

fomentations  for,  195 
how  to  remove  foreign  bod- 
ies from,  332 
treatment  of,  167 
Eyelid,  how  to  evert,  333 
Eyestrain,  80 

Fainting,  266 

Fever,  120 

Fire,  how  to  put  out,  332 

First  aid,  principles  of,  257 

Flaxseed  poultice,  188 

Flies,  how  they  transmit  dis- 
ease, 23 

Fomentations,  175 

Foot-bath,  in 

Foreign  body,  removal  of,  from 

alimentary  tract,  335 
removal  of,  from  ear,  333 
removal  of,  from  eye,  332 
removal  of,  from  nose,  334 
removal    of,    from   trachea, 

334 

Fractures,  304 
Freezing,  328 
Frost-bite,  329 

Hair,  care  of  the,  104 

how  to  comb  and  brush  the, 
62 

how  to  wash  the,  109 
Health,  requirements  for,  216 
Heart  action,  how  controlled, 


Index 


357 


Heart,  structure  of  the,  128 
Heat,  how  formed  in  the  body, 

118 
how    lost   from    the    body, 

119 

prostration,  270 
Hemorrhage,  how  to  control, 

313 

symptoms  of,  312 
where  pressure  is  made  to 

control,  316 
Hot-water  bag,  care  of,  30 

how  to  fill,  179 
Humidity,  15-17 
Hysteria,  267,  272,  273 

Ice-cap,  care  of,  30 

how  to  fill,  181 
Immunity,  25 
Incubation,  what  is  meant  by 

the  period  of,  27 
Inflammation,  296 
Inhalation,  150 

Iron,  how  used  to  relieve  pain, 
1 80 

Lifting  an  unconscious  patient 

from  the  floor,  277 
a  patient,  methods  of,  37-43 
Liniments,  174 
Lysol,  33 

Medicines,    important    points 
to  remember  regarding  the 
care  and  use  of,  142 
methods  of  giving,  139 
uses  of,  139 

Mental  development,  209 

Milk,  modification  of,  233 

pasteurization  of,  239 


Mosquitoes,  how  they  transmit 

disease,  24 
Moving  patients,  methods  of, 

37-43 

Muscle  tone,  92 
Mustard,  83 

pastes,  184 

poultice,  190 

Nasal  douche,  145 
Nightgown,  how  to  change, 

55 

Nipples,  care  of  bottle,  232 
Nose,  application  of  medicine 

to, 148 
removal    of    foreign     body 

from,  333 

Odors,  causes  of,  in  sick-room, 

18 
Ointments,  174 

Pastes,  175 

Patient,  preparation  of,  for  the 

night,  59 
Plasters,  174 
Poisoning,  symptoms  of,  338 

treatment  for,  340 
Poisons,  classification  of,  336 
how   formed   in   the   body, 

263 

Poultices,  175-185 
Pressure-sores,  67 
Pulse,  how  to  count  the, 

138 

normal  rate  of,  130 
what    is    meant     by     the, 
127 

Records,  how  to  keep,  138 


358 


Index 


Respiration,  132 
Rubber,  care  of,  30 

Salt,    external    use    of    hot, 
1 80 

Scalds,  326 

Scars,  nature  of,  291 

Shock,  260,  265 

Sick-room,      desirable     char- 
acteristics of,  7 
how  to  clean,  27-29 
what  is  involved  in  the  care 
of  a,  10 

Skin,  uses  of  applications  to 
the,  131 

Slings,  256 

Solutions,  nature  of,  174 

Sound, 160 

Sprains,  311 

Stains,  how  to  remove,  31 

Stupes,  175 

Sunstroke,  268 

Tear  ducts  and  glands,  331 
Temperature,  definition  of,  116 
for  infant's1  bath,  219 
how  to  take  an  infant's,  218 
how  to  take  by  axilla,  127 


how  to  take  by  mouth,  125 
suitable  for  sick-room,  21 
terms    used    in    describing 

different  degrees  of,  123 
Thermometers,  123 
Throat,  application  of  medi- 
cine to  the,  149 
Trachea,   removal  of  foreign 
body  from  the,  334 

Unconsciousness,  259 
Unslaked  lime,  34 
Uremia,  272 

Utensils,  how  to  clean,  29-31 
how  to  disinfect,  32 

Ventilation,  10-22 

Winds,  causes  of,  13 
Wound,  changing  the  dressing 
on  a,  302 

dressing  a  simple,  298 

first  aid  treatment  of,  293 

healing  of,  289 

infection  of,  294 

nature  and  classification  of, 

287 
Wrapper,  how  to  put  on,  87 


INDEX  OF  DEMONSTRATIONS 


DEMONSTRATIONS 

PAGE 

List  of 
Equipment. 

Procedure. 

I.  Methods  of  ventilating  and  cleaning 

a  sick-room.     Care  of  utensils  used 

for  the  sick. 

6 

6-  36 

2  .  Moving  ,  lifting  ,  and  carrying  a  patient 

37 

40-  45 

3.  Stripping  a  bed.     Making  a  closed 

bed. 

46 

47-  52 

4.  Changing  the  sheets  with  a  patient  in 

bed.     Changing  a  patient's  night- 

gown. 

52 

52-  58 

5.  Preparation    of    a    patient    for    the 

night. 

59 

59 

6.  Methods  of  making  a  patient  com- 

fortable. 

82 

83 

7.  Preparing  a  patient  to  get  out  of  bed 

and  making  her  comfortable  in  a 

chair.     Helping  a  patient  get  into 

bed. 

86 

87 

8.  Giving  a  cleansing  bath  to  a  patient 

in  bed. 

99 

99 

9.  Cleaning  the  hair. 

107 

107 

10.  Washing  the  hair. 

1  08 

109 

ii.  Giving  a  foot-bath. 

in 

111-115 

12.  Taking  the  temperature. 

125 

126 

13.  Counting  the  pulse  and  breathing. 

136 

138 

14.  Measuring  medicine. 

»45 

MS 

15.  Application     of     medicine     to     the 

throat. 

154 

156 

359 


360       Tndex  of  Demonstrations 

INDEX  OF  DEMONSTRATIONS— Continued 


DEMONSTRATIONS 

PAGE 

List  of 
Equipment. 

Procedure. 

16.  Irrigation  of  the  ear. 

162 

164 

17.  Methods  of  irrigating  and  putting 

medicine  in  the  eye. 

167 

169 

1  8.  Methods  of  using  iodine,  liniments, 

ointments,  and  articles  employed  for 

the  application  of  cold  to  the  body. 

175 

176-182 

19.  Preparing,   applying,  and   removing 

sinapisms. 

182 

184 

20.  Making  and  applying  poultices. 

185 

188-191 

21.  Application     of     fomentations     or 

stupes. 

192 

193 

22.  Lifting,      weighing,      bathing,     and 

dressing  a  baby. 

218 

223 

23.  Preparation    of    an    infant's    food. 

Care  of  feeding-bottles,  nipples,  and 

utensils  used  in  the  preparation  of 

food. 

226 

236 

24.  Bandaging. 

241 

245-256 

25.  Lifting  an  unconscious  patient  from 

the  ground. 

277 

26.  Treatment  of  a  person  rescued  from 

drowning.   Artificial  respiration. 

279 

283-285 

27.  Dressing  a  simple  wound. 

287 

298 

28.  First  aid  treatment    in    hemorrhage 

and  fractures. 

304 

320 

29.  Extinguishing  fire. 

321 

324 

./?  Selection  from  the 
Catalogue  of 

G.  P.  PUTNAM'S   SONS 


Complete   Catalogues  sent 
on  application 


'1  consider  It  the  best  I  have  seen  and  shall  recommend  Its  uoe 
IB  our  school." — Kate  A.  Sanborn.  Supt.  of  Training  School  for  Nurses, 
St.  Vincent's  Hospital. 


Essentials  of  Dietetics 

In  Health  and  Disease 

A  Text-Book  for  Nurses  and  a  Practical  Dietary 
Guide  for  the  Household 

By  AMY  ELIZABETH  POPE 

Instructor  In  tbe  Presbyterian  Hospital  School  of  Nursing; 
St.  Luke's  Hospital,  San  Francisco.  Calif. 

and 

MARY  L.  CARPENTER 

Director  of  Domestic  Science  in  the  Public  Schools 
Saratoga  Springs,  N.  Y. 

Second  Edition,  Revised  and  Enlarged 
Crown  8vo.     Illustrated 


Essentials  of  Dietetics  is  primarily  a  text-book,  intended  to 
facilitate  the  teaching  of  dietetics  in  schools  of  nursing.  Its  aim 
is  to  furnish  nurses  with  such  information  as  is  indispensable, 
and  can  be  assimilated  in  the  time  given  to  the  study  of  dietetics 
in  the  nursing-school  curriculum.  It  is  also  adapted  to  use  as  a 
dietary  guide  for  the  home.  At  least  one-third  of  the  women 
who  enter  the  larger  schools  of  nursing  do  so  with  the  desire  of 
being  prepared  to  take  charge  of  hospitals  or  to  do  settlement 
work,  and  in  both  these  branches  of  the  nursing  profession  hardly 
any  one  thing  is  more  important  than  knowing  how  to  direct  the 
buying,  preservation,  cooking,  and  serving  of  food.  To  do  this 
intelligently  it  is  absolutely  necessary  to  have  some  knowledge 
of  the  chemistry  of  foods,  of  the  special  uses  of  the  various  food 
principles  to  the  body,  of  the  proportions  in  which  they  are  con- 
tained  in  tho  different  foods,  and  of  the  effect  on  them  of  acids, 
heat,  salt,  digestive  ferments,  etc. 


Q.  P    PUTNAM'S  SONS 

NEW  YORK  LONDON 


For  Those  Whose  Work  Is  Among  Children 

The  School  Nurse 

By 
Lina  Rogers  Struthers 

First  Municipal  School  Nurse 
72°.      24  Illustrations 

This  Book  is  a  Survey  of  the   Duties  and 
Responsibilities  of  the  Nurse 

in  the  maintenance  of  health  and  physical  perfection 
and  the  prevention  of  disease  among  school  children. 

The  school  nurse  has  been  a  great  factor  in  com- 
munity welfare  and  has  strengthened  the  intimate 
relations  between  the  school  and  the  home. 

School  nursing  is  still  in  its  infancy  and  many 
changes  in  methods  are  to  be  expected,  but  the  under- 
lying essentials — child  love  and  preservation  of  child 
health — will  exist  as  long  as  child  life. 

By  virtue  of  her  pioneer  labor  in  this  special 
branch  of  nursing  and  also  because  of  her  subsequent 
extensive  experience  and  recognized  position  in  the 
field,  Lina  Rogers  Struthers,  R.N.,  First  Municipal 
School  Nurse,  is  fitted  as  are  few  others  to  counsel 
and  guide  those  who  are  engaged  in  or  who  contem- 
plate pursuing  school  nursing.  Mrs.  Struthers's  book 
is  the  result  of  painstaking  experience  and  careful 
study  of  the  requirements  of  school  nursing. 


G.  P.  Putnam's  Sons 

New  York  London 


The  Home  Care  of 
Consumptives 

By 
Roy  L.  French 

Former  Secretary,  Kentucky  Tuberculosis  Commission 
12°. 

The  successful  home  treatment  of  a  consumptive 
patient  depends  on  the  intelligent,  hopeful,  persistent 
cooperation  of  the  patient  and  family  with  the  physician. 
This  cooperation  must  be  based  on  exact  information  as 
to  what  to  do  and  how  to  do  it.  This  book  will  not  take 
the  place  of  medical  supervision,  which  is  necessary  in 
every  instance.  But  it  supplies  a  fund  of  information 
which  will  make  that  cooperation  possible.  Physicians, 
social  workers,  nurses,  and  teachers  will  also  find  here 
much  valuable  material. 

Suggestions  to  Physicians 

1.  Leave  a  reference  copy  on  the  reading  table  of 
your  dispensary  or  sanatorium  waiting  room. 

2.  Provide  visiting  nurses  with  copies  to  lend  to  the 
more  intelligent  patients. 

3.  Patients  in  sanatoria  and  camps  will  learn  much  by 
reading  this  volume.    A  sufficient  number  of  copies  to 
lend  would  be  desirable. 

4.  Many  patients,  discharged  or  arrested,  lose  in  a 
month  the  gain  of   a  year.    Why?    They  forget  your 
instructions  about  exercise ;  or  they  do  not  know  how  to 
arrange  for  themselves  at  home  the  same  diet  you  take  so 
much  pains  in  preparing.    This  book  meets  that  need. 
Suggest  that  each  discharged  patient  has  a  copy. 

5.  No  better  use  for  a  small-fund  can  be  found  than  to  put  a 
copy   of  this  book  into   the   hands   of  every   known  tubercular 
family  in  your  territory,  by  gift  or  loan. 

G.  P.  Putnam's  Sons 

New  York  London 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


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